Wadhera Sarthak, Rastogi Ashu, Dutta Pinaki, Gupta Ankur, Bhadada Sanjay K
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Endocrinol Metab. 2022 Jul-Aug;26(4):362-371. doi: 10.4103/ijem.ijem_99_22. Epub 2022 Sep 20.
Cardiac autonomic neuropathy (CAN) in people with diabetes is associated with high mortality. We aimed to study age and disease duration, independent prevalence of CAN in people with diabetic foot complications.
530 patients with diabetes were screened to undergo CAN assessment (automated CANS-analyser). CAN was defined as "early", "definite," or "severe" according to the Toronto consensus. History pertaining to autonomic symptoms, prior cardiovascular events (CVE), and assessment for peripheral neuropathy was done. Participants were grouped into those with diabetic foot complication (group A, n = 82) [Charcot foot (n = 42), diabetic foot ulcer (n = 40)]; with DPN without foot complications (group B, n = 82); and without DPN or foot complications (group C, n = 82).
Symptoms of autonomic dysfunction were prominent in people with foot complications than the other groups. Resting heart rate was significantly greater in those with foot complications [99.89 ± 26.71 (group A) vs. 86.99 ± 22.24 (group B) vs. 88.32 ± 17.08 (group C); P = 0.001]. The prevalence of CAN was 75.6% in group A (51.2% early, 12.2% definite, 12.2% severe), 57.2% in group B (45.1% early, 12.2% severe) and 58.5% in group C (43.9% early, 1.2% definite, 13.4% severe) (P = 0.002). Patients with foot complications were more likely to have CAN (75.6% vs. 57.9%, P < 0.001). Charcot foot had higher prevalence of CAN (78.6%) as compared with those with DFU (72.5%) or without DFU or DPN (57.9%), P < 0.001.
CAN is present in more than two-third of patients with diabetes and foot complications with highest prevalence in Charcot neuroarthropathy.
糖尿病患者的心脏自主神经病变（CAN）与高死亡率相关。我们旨在研究年龄和病程，以及糖尿病足并发症患者中CAN的独立患病率。
对530例糖尿病患者进行筛查以进行CAN评估（自动CANS分析仪）。根据多伦多共识，CAN被定义为“早期”、“明确”或“严重”。记录自主神经症状、既往心血管事件（CVE）以及周围神经病变的评估情况。参与者被分为有糖尿病足并发症的患者（A组，n = 82）[夏科氏足（n = 42），糖尿病足溃疡（n = 40）]；有糖尿病周围神经病变但无足部并发症的患者（B组，n = 82）；以及无糖尿病周围神经病变或足部并发症的患者（C组，n = 82）。
足部并发症患者的自主神经功能障碍症状比其他组更为突出。足部并发症患者的静息心率显著更高[99.89±26.71（A组）对86.99±22.24（B组）对88.32±17.08（C组）；P = 0.001]。A组CAN的患病率为75.6%（早期51.2%，明确12.2%，严重12.2%），B组为57.2%（早期45.1%，严重12.2%），C组为58.5%（早期43.9%，明确1.2%，严重13.4%）（P = 0.002）。足部并发症患者更易患CAN（75.6%对57.9%，P < 0.001）。与糖尿病足溃疡患者（72.5%）或无糖尿病足溃疡或糖尿病周围神经病变的患者（57.9%）相比，夏科氏足患者CAN的患病率更高（78.6%），P < 0.001。
超过三分之二的糖尿病足并发症患者存在CAN，在夏科氏神经关节病中患病率最高。
