Bitsch Poulsen Maria, Wegeberg Anne-Marie, Røikjer Johan, Nikontovic Amar, Vestergaard Peter, Brock Christina
Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Acta Diabetol. 2025 May;62(5):707-716. doi: 10.1007/s00592-024-02390-2. Epub 2024 Nov 6.
Diabetic autonomic neuropathy is a severe complication of diabetes, estimated to affect up to 44% in type 1 diabetes (T1D) and 73% in type 2 diabetes (T2D) based on clinical studies. Currently, the assessment of diabetic autonomic neuropathy is not implemented in Denmark's clinical guidelines, complicating the estimation of the true prevalence. Thus, this study investigated the prevalence of self-reported symptoms of autonomic dysfunction in people living with diabetes in the North Denmark Region using the Composite Autonomic Symptoms Score (COMPASS)-31 questionnaire.
In 2022, all adults with T1D or T2D in the North Denmark Region (n = 29,155) were identified using The National Health Insurance Service Registry and invited to an online survey including the Danish version of COMPASS-31. The prevalence and associated 95% confidence intervals (CI) for symptomatic autonomic dysfunction were determined using a cut-off value of 16.
In total, 7,377 completed COMPASS-31, of which 82.4% reported having T2D and 13.7% T1D. The prevalence of symptomatic autonomic dysfunction was 36.8% (95% CI: 34-40) after a median of 26 years with diabetes for T1D and 44.2% (95% CI: 43-45) after a median of 10 years for T2D. Pupillary and orthostatic intolerance were the most frequent moderate to severe symptoms, respectively (38.4% and 24.0% in T1D and 32.8% and 26.3% in T2D).
Symptoms of autonomic dysfunction are very common in individuals with diabetes living in the North Denmark Region, emphasizing the unmet need for regular testing to increase awareness and allow for adequate management, ultimately reducing the morbidity of diabetes.
糖尿病自主神经病变是糖尿病的一种严重并发症，根据临床研究估计，1型糖尿病（T1D）患者中高达44%受其影响，2型糖尿病（T2D）患者中则为73%。目前，丹麦临床指南中未实施糖尿病自主神经病变的评估，这使得估计其真实患病率变得复杂。因此，本研究使用综合自主神经症状评分（COMPASS）-31问卷调查了丹麦北部地区糖尿病患者自我报告的自主神经功能障碍症状的患病率。
2022年，利用国家医疗保险服务登记处识别出丹麦北部地区所有患有T1D或T2D的成年人（n = 29,155），并邀请他们参加一项在线调查，其中包括丹麦版的COMPASS-31。使用截断值16确定有症状自主神经功能障碍的患病率及相关的95%置信区间（CI）。
共有7377人完成了COMPASS-31，其中82.4%报告患有T2D，13.7%患有T1D。T1D患者糖尿病病程中位数为26年后，有症状自主神经功能障碍的患病率为36.8%（95%CI：34 - 40）；T2D患者糖尿病病程中位数为10年后，患病率为44.2%（95%CI：43 - 45）。瞳孔和体位性不耐受分别是最常见的中度至重度症状（T1D中分别为38.4%和24.0%，T2D中分别为32.8%和26.3%）。
丹麦北部地区糖尿病患者中自主神经功能障碍症状非常普遍，这凸显了定期检测的未满足需求，以提高认识并实现充分管理，最终降低糖尿病的发病率。
