Vascular dysfunction and autonomic neuropathy in Type 2 diabetes.

Full Abstract

AIMS: To test the hypothesis that arterial dysfunction in Type 2 diabetes is related to autonomic neuropathy. METHODS: Arterial function and autonomic neuropathy were assessed over two consecutive days in 45 Type 2 diabetic and control subjects. Systemic arterial compliance (SAC), arterial stiffness (pulse-wave velocity, PWV) and carotid intima thickness (IMT) were assessed; these markers reflect early vascular disease and predict clinical vascular events. Autonomic neuropathy was assessed using heart rate variability with continuous ECG recording during various breathing and postural manoeuvres and an overall autonomic score was generated. Fasting metabolic parameters including glucose, insulin, HbA(1c) and lipid profile were measured. RESULTS: Autonomic neuropathy tests were all repeatable in diabetic subjects. Compared with controls, diabetic subjects had arterial dysfunction with increased PWV (P = 0.009), IMT (P < 0.001) and reduced SAC (P = 0.053). After adjustment for age, central PWV correlated with fasting insulin (r(2) = 0.45, P < 0.05) and autonomic score (r(2) = 0.44, P < 0.05), peripheral PWV correlated with autonomic score (r(2) = 0.51, P < 0.005) and IMT correlated with fasting insulin (r(2) = 0.5, P < 0.005). The presence of autonomic neuropathy correlated with fasting insulin (P = 0.015), but not age, duration diabetes, lipids or blood pressure. CONCLUSION: Using repeatable measures of autonomic neuropathy and vascular function in Type 2 diabetic subjects, we have demonstrated associations between autonomic neuropathy, vascular dysfunction and hyperinsulinaemia. This may help to explain the excess cardiovascular mortality seen in diabetic subjects with autonomic neuropathy.

Author information

Author/s: Meyer, C (C); Milat, F (F); McGrath, B P (BP); Cameron, J (J); Kotsopoulos, D (D); Teede, H J (HJ);

Affiliation: Monash University Department of Medicine, Dandenong Hospital, David Street, Dandenong,Victoria 3175, Australia.

Journal and publication information

Publication Type: Journal Article

Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med), published in England. (Language: eng)

Reference: 2004-Jul; vol 21 (issue 7) : pp 746-51

Dates: Created 2004/06/22; Completed 2004/09/28; Revised 2004/11/17;

PMID: 15209768, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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