Abstract:
Introduction: Cardiovascular form of diabetic autonomic neuropathy (CDAN) is represented by
sympathetic (accelerative) and/or parasympathetic (inhibitive) influence upon cardiovascular system
induced by prolonged action of elevated glicemia. CDAN perturbs cotidian usual activity, decreases life
quality, increases mortality level and also it occupies an imposing part of healthcare service costs[2].
According to different studies, CDAN prevalence variates between 16,8 - 25,3% in diabetes type 1 and
22,1 - 34,3% in type 2. [3]
CDAN manifestations such as decrease in effort toleration level and silent ischemia, determine an unfavourable prognosis, as a result myocardial infarction develops 50% more frequently in CDAN diabetics
versus non-CDAN (Valensi J. 2001). Prolonged QTc interval, being an independent predictive factor of
cardiovascular mortality, is associated with a high risk of developing malignant ventricular arrhythmias
and sudden death.
Prompt diagnosis and chronic complications screening of diabetes have a positive impact upon therapeutic efficiency, life quality improvement and decrease in mortality level.
Objectives: Frequency determination of cardiovascular form of diabetic autonomic neuropathy depending on type of diabetes, its duration in concordation with clinical and paraclinical data.
Materials and methods: There have been examined 72 patients (18 with type 1 diabetes and 54 with
type 2) through clinical (examination, inquiry) and paraclinical (Ewing tests, QTc interval, sinus rhythm
variability, circadian index) methods. This patients were divided, according to diabetes duration, into 3
groups - A(0-5years), B(5-10years) and C(>10years).
Results: In group of patients with type 1 diabetes, CDAN incidence - 22,2% (4 pts). Group A: 6 pts.,
with average duration of diabetes 2,4±3,2years - there wasn’t any data of CDAN. Group B: 8 pts., average
duration 9,4±l,6years, signs of CDAN were determined in 2 pts (25%). In group C: 4 pts., average duration 17,5±6,2years - 2 pts (50%).
In group of patients with type 2 diabetes, CDAN incidence - 29,6% (16 pts). Group A: 17 pts., average duration 2,89±l,62years - CDAN datas in 17%. Group B: 21 pts., average duration 10,32±l,5years,
CDAN in 43% cases. In group C: 16 pts., average duration 17,56±4,8years, CDAN signs in 25% cases.
Conclusions: In type 1 diabetes first signs appear after a diabetic evolution of over 5 years with subsequent incidence elevation directly proportional to diabetes duration. In type 2 diabetes CDAN manifestations may be present during primary diagnosis, determining an insignificant increase in incidence
during evolution.
All patients with type 1 diabetes with diabetic duration over 5 years and patients with type 2 diabetes
during diagnosis - require evaluation against CDAN.
Clinical manifestations of DAN may significantly affect patients life, however it continues to be frequently misdiagnosed [1]. Application of functional tests, ECG, inquiry and Holter-ECG monitoring
distinguish precocious signs of CDAN much before suggestive clinical manifestations.
