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Limits of clinical tests to screen autonomic function in diabetes type 1.
Diabetes Metab. 2001 Nov; 27(5 Pt 1):545-50.DM

Abstract

OBJECTIVES

A precocious detection of cardiac autonomic dysfunction is of major clinical interest that could lead to a more intensive supervision of diabetic patients. However, classical clinical exploration of cardiac autonomic function is not easy to undertake in a reproducible way. Thus, respective interests of autonomic nervous parameters provided by both clinical tests and computerized analysis of resting blood pressure were checked in type 1 diabetic patients without orthostatic hypotension and microalbuminuria.

MATERIAL AND METHODS

Thirteen diabetic subjects matched for age and gender to thirteen healthy subjects volunteered to participate to the study. From clinical tests (standing up, deep breathing, Valsalva maneuver, handgrip test), autonomic function was scored according to Ewing's methodology. Analysis of resting beat to beat blood pressure provided autonomic indices of the cardiac function (spectral analysis or Z analysis).

RESULTS

5 of the 13 diabetic patients exhibited a pathological score (more than one pathological response) suggesting the presence of cardiovascular autonomic dysfunction. The most discriminative test was the deep breathing test. However, spectral indices of BP recordings and baro-reflex sensitivity (BRS) of these 5 subjects were similar to those of healthy subjects and of remaining diabetic subjects.

CONCLUSION

Alteration in Ewing's score given by clinical tests may not reflect an alteration of cardiac autonomic function in asymptomatic type 1 diabetic patients, because spectral indices of sympathetic and parasympathetic (including BRS) function were within normal range. Our results strongly suggest to confront results provided by both methodologies before concluding to an autonomic cardiac impairment in asymptomatic diabetic patients.

Authors+Show Affiliations

Département de Néphrologie et Hypertension Artérielle, Hopital E. Herriot, Lyon, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11694853

Citation

Ducher, M, et al. "Limits of Clinical Tests to Screen Autonomic Function in Diabetes Type 1." Diabetes & Metabolism, vol. 27, no. 5 Pt 1, 2001, pp. 545-50.
Ducher M, Bertram D, Sagnol I, et al. Limits of clinical tests to screen autonomic function in diabetes type 1. Diabetes Metab. 2001;27(5 Pt 1):545-50.
Ducher, M., Bertram, D., Sagnol, I., Cerutti, C., Thivolet, C., & Fauvel, J. P. (2001). Limits of clinical tests to screen autonomic function in diabetes type 1. Diabetes & Metabolism, 27(5 Pt 1), 545-50.
Ducher M, et al. Limits of Clinical Tests to Screen Autonomic Function in Diabetes Type 1. Diabetes Metab. 2001;27(5 Pt 1):545-50. PubMed PMID: 11694853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Limits of clinical tests to screen autonomic function in diabetes type 1. AU - Ducher,M, AU - Bertram,D, AU - Sagnol,I, AU - Cerutti,C, AU - Thivolet,C, AU - Fauvel,J P, PY - 2001/11/6/pubmed PY - 2002/2/14/medline PY - 2001/11/6/entrez SP - 545 EP - 50 JF - Diabetes & metabolism JO - Diabetes Metab VL - 27 IS - 5 Pt 1 N2 - OBJECTIVES: A precocious detection of cardiac autonomic dysfunction is of major clinical interest that could lead to a more intensive supervision of diabetic patients. However, classical clinical exploration of cardiac autonomic function is not easy to undertake in a reproducible way. Thus, respective interests of autonomic nervous parameters provided by both clinical tests and computerized analysis of resting blood pressure were checked in type 1 diabetic patients without orthostatic hypotension and microalbuminuria. MATERIAL AND METHODS: Thirteen diabetic subjects matched for age and gender to thirteen healthy subjects volunteered to participate to the study. From clinical tests (standing up, deep breathing, Valsalva maneuver, handgrip test), autonomic function was scored according to Ewing's methodology. Analysis of resting beat to beat blood pressure provided autonomic indices of the cardiac function (spectral analysis or Z analysis). RESULTS: 5 of the 13 diabetic patients exhibited a pathological score (more than one pathological response) suggesting the presence of cardiovascular autonomic dysfunction. The most discriminative test was the deep breathing test. However, spectral indices of BP recordings and baro-reflex sensitivity (BRS) of these 5 subjects were similar to those of healthy subjects and of remaining diabetic subjects. CONCLUSION: Alteration in Ewing's score given by clinical tests may not reflect an alteration of cardiac autonomic function in asymptomatic type 1 diabetic patients, because spectral indices of sympathetic and parasympathetic (including BRS) function were within normal range. Our results strongly suggest to confront results provided by both methodologies before concluding to an autonomic cardiac impairment in asymptomatic diabetic patients. SN - 1262-3636 UR - https://www.unboundmedicine.com/medline/citation/11694853/Limits_of_clinical_tests_to_screen_autonomic_function_in_diabetes_type_1_ L2 - https://www.diseaseinfosearch.org/result/2236 DB - PRIME DP - Unbound Medicine ER -