Prevalence and Correlates of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes in Uganda: A Hospital-Based Cross-sectional Study

Overview

Journal Glob Heart

Publisher Ubiquity Press

Specialty Cardiology & Vascular Diseases

Date 2020 Jun 4

PMID 32489794

Citations 6

Authors

Richard Migisha

David Collins Agaba

Godfrey Katamba

Teddy Kwaga

Raymond Tumwesigye

Silvia Lopez Miranda

Anthony Muyingo

Mark J Siedner

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular autonomic neuropathy (CAN) is a common complication in individuals with diabetes mellitus (DM) but often overlooked in clinical practice. The burden and correlates of CAN have not been extensively studied in low-income countries, particularly in sub-Saharan Africa.

Objectives: To determine the prevalence and correlates of CAN among adults in ambulatory diabetes care in southwestern Uganda.

Method: We conducted a cross-sectional study among adults with diabetes from November 2018 to April 2019. CAN was assessed using the five autonomic function tests: deep breathing, Valsalva maneuver, postural index on standing, change in blood pressure during standing and diastolic blood pressure response to isometric exercise. We estimated the prevalence of CAN and fit regression models to identify its demographic and clinical correlates.

Results: We enrolled 299 individuals. The mean age was 50.1 years (SD ± 9.8), mean HbA1c was 9.7 (SD ± 2.6) and 69.6% were female. CAN was detected in 156/299 (52.2%) of the participants on the basis of one or more abnormal cardiovascular autonomic reflex tests. Out of 299 participants, 88 (29.4%) were classified as early CAN while 61/299 (20.4%) and 7/299 (2.3%) were classified as definite and severe (advanced) CAN respectively. In multivariable regression models, age over 50 years (aOR 3.48, 95%CI 1.35 -8.99, p = 0.010), duration of diabetes over 10 years (aOR 4.09, 95%CI 1.78 -9.38, p = 0.001), and presence of diabetic retinopathy (aOR 2.25, 95%CI 1.16 -4.34, p = 0.016) were correlated with CAN.

Conclusions: Our findings reveal a high prevalence of CAN among individuals in routine outpatient care for diabetes mellitus in Uganda. Older age, longer duration of diabetes and coexistence of retinopathy are associated with CAN. Future work should explore the clinical significance and long term outcomes associated with CAN in this region.

Citing Articles

Evaluating treatment options for cardiovascular autonomic neuropathy in patients with diabetes mellitus: a systematic review.

Goh J, Koh L Diabetol Int. 2023; 14(3):224-242.

PMID: 37397902 PMC: 10307756. DOI: 10.1007/s13340-023-00629-x.

High prevalence of prolonged QTc interval among individuals in ambulatory diabetic care in southwestern Uganda.

Migisha R, Agaba D, Katamba G, Miranda S, Muyingo A, Siedner M Int J Diabetes Dev Ctries. 2022; 41(4):614-620.

PMID: 35177883 PMC: 8849522. DOI: 10.1007/s13410-021-00944-6.

Mbarara University Research Training Initiative: Experiences and Accomplishments of the MEPI Junior D43 TW010128 Award in Uganda.

Wakida E, Atuhaire C, Karungi C, Maling S, Obua C Adv Med Educ Pract. 2021; 12:1397-1410.

PMID: 34887692 PMC: 8650769. DOI: 10.2147/AMEP.S339752.

High prevalence of uncontrolled hypertension among patients with type 2 diabetes mellitus: a hospital-based cross-sectional study in Southwestern Uganda.

Saasita P, Senoga S, Muhongya K, Agaba D, Migisha R Pan Afr Med J. 2021; 39:142.

PMID: 34527158 PMC: 8418183. DOI: 10.11604/pamj.2021.39.142.28620.

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications.

Duque A, Mediano M, De Lorenzo A, Rodrigues Jr L World J Diabetes. 2021; 12(6):855-867.

PMID: 34168733 PMC: 8192252. DOI: 10.4239/wjd.v12.i6.855.

References

Witte D, Tesfaye S, Chaturvedi N, Eaton S, Kempler P, Fuller J . Risk factors for cardiac autonomic neuropathy in type 1 diabetes mellitus. Diabetologia. 2004; 48(1):164-71. DOI: 10.1007/s00125-004-1617-y. View

Ratzmann K, Raschke M, Gander I, Schimke E . Prevalence of peripheral and autonomic neuropathy in newly diagnosed type II (noninsulin-dependent) diabetes. J Diabet Complications. 1991; 5(1):1-5. DOI: 10.1016/0891-6632(91)90002-7. View

Valensi P, Johnson N, Maison-Blanche P, Extramania F, Motte G, Coumel P . Influence of cardiac autonomic neuropathy on heart rate dependence of ventricular repolarization in diabetic patients. Diabetes Care. 2002; 25(5):918-23. DOI: 10.2337/diacare.25.5.918. View

Bonnemeier H, Richardt G, Potratz J, Wiegand U, Brandes A, Kluge N . Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol. 2003; 14(8):791-9. DOI: 10.1046/j.1540-8167.2003.03078.x. View

Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R . Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011; 27(7):639-53. DOI: 10.1002/dmrr.1239. View

Esler M, Hastings J, Lambert G, Kaye D, Jennings G, Seals D . The influence of aging on the human sympathetic nervous system and brain norepinephrine turnover. Am J Physiol Regul Integr Comp Physiol. 2002; 282(3):R909-16. DOI: 10.1152/ajpregu.00335.2001. View

. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143-421. View

Jeppsson J, Kobold U, Barr J, Finke A, Hoelzel W, Hoshino T . Approved IFCC reference method for the measurement of HbA1c in human blood. Clin Chem Lab Med. 2002; 40(1):78-89. DOI: 10.1515/CCLM.2002.016. View

Zoppini G, Cacciatori V, Raimondo D, Gemma M, Trombetta M, Dauriz M . Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS). Diabetes Care. 2015; 38(8):1487-93. DOI: 10.2337/dc15-0081. View

10.

Maser R, Mitchell B, Vinik A, Freeman R . The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003; 26(6):1895-901. DOI: 10.2337/diacare.26.6.1895. View

11.

Ziegler D, Gries F, Muhlen H, Rathmann W, Spuler M, Lessmann F . Prevalence and clinical correlates of cardiovascular autonomic and peripheral diabetic neuropathy in patients attending diabetes centers. The Diacan Multicenter Study Group. Diabete Metab. 1993; 19(1 Pt 2):143-51. View

12.

Ziegler D, Dannehl K, Muhlen H, Spuler M, Gries F . Prevalence of cardiovascular autonomic dysfunction assessed by spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses at various stages of diabetic neuropathy. Diabet Med. 1992; 9(9):806-14. DOI: 10.1111/j.1464-5491.1992.tb01898.x. View

13.

Vinik A, Casellini C, Parson H, Colberg S, Nevoret M . Cardiac Autonomic Neuropathy in Diabetes: A Predictor of Cardiometabolic Events. Front Neurosci. 2018; 12:591. PMC: 6119724. DOI: 10.3389/fnins.2018.00591. View

14.

Vinik A, Erbas T, Casellini C . Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013; 4(1):4-18. PMC: 3580884. DOI: 10.1111/jdi.12042. View

15.

Valensi P, Paries J, Attali J . Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications--the French multicenter study. Metabolism. 2003; 52(7):815-20. DOI: 10.1016/s0026-0495(03)00095-7. View

16.

Pappachan J, Sebastian J, Bino B, Jayaprakash K, Vijayakumar K, Sujathan P . Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgrad Med J. 2008; 84(990):205-10. DOI: 10.1136/pgmj.2007.064048. View

17.

Vinik A, Ziegler D . Diabetic cardiovascular autonomic neuropathy. Circulation. 2007; 115(3):387-97. DOI: 10.1161/CIRCULATIONAHA.106.634949. View

18.

Bellavere F, Bosello G, Fedele D, Cardone C, Ferri M . Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed). 1983; 287(6384):61. PMC: 1548146. DOI: 10.1136/bmj.287.6384.61-a. View

19.

Jung C, Kim B, Kim C, Kang S, Jung S, Mok J . Association of serum adipocytokine levels with cardiac autonomic neuropathy in type 2 diabetic patients. Cardiovasc Diabetol. 2012; 11:24. PMC: 3353195. DOI: 10.1186/1475-2840-11-24. View

20.

Ewing D, Martyn C, Young R, CLARKE B . The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care. 1985; 8(5):491-8. DOI: 10.2337/diacare.8.5.491. View