Analysis of the association between glucose profiles and β-cell function for diabetic cardiovascular autonomic neuropathy in China

Study on the Correlation of Skin Advanced Glycation End Products With Diabetic Cardiovascular Autonomic Neuropathy

Aim

To investigate the correlation of advanced glycation end products (AGEs) with diabetic cardiovascular autonomic neuropathy (DCAN). Factors affecting DCAN and those related to skin AGE accumulation in patients with DCAN were analyzed.

Materials and Methods

A total of 192 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in the Department of Endocrinology of Hefei Second People's Hospital from November 2020 to December 2022 were included and divided into DCAN (n=121) and No_DCAN (n=71) groups based on the results of Ewing test. All patients completed the detection of skin AGEs accumulation. The clinical features of the two groups were analyzed; the factors affecting DCAN were analyzed by multiple logistic regression analysis, and those related to skin AGE accumulation in patients with DCAN were analyzed by Spearman correlation analysis and Pearson correlation analysis.

Results

Compared with the No_DCAN group, the combined DR ratio, fasting plasma glucose (FPG), and skin AGEs were increased in the DCAN group (all P<0.05). Multivariate logistic regression analysis showed that FPG, combined DR, and skin AGEs all affected DCAN (P<0.05). Spearman correlation analysis showed that skin AGE accumulation in patients with DCAN was correlated with sex (male or female) and the presence of vascular plaques (All P<0.05). Pearson correlation analysis showed that skin AGE accumulation in patients with DCAN was correlated with age, diabetes course, diastolic blood pressure, uric acid, creatinine and UACR levels (All P<0.05).

Conclusion

Skin AGEs, combined DR and FPG affected DCAN, and skin AGEs, combined DR and FPG were closely related to the incidence of DCAN. Sex (male or female), presence of vascular plaques, age, diabetes course, diastolic blood pressure, uric acid levels, creatinine levels and UCAR levels were correlated with skin AGE accumulation in patients with DCAN.

The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review

BACKGROUND

Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN.

METHODS

The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review.

RESULTS

Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes.

CONCLUSIONS

Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.

The Relationship Between β-cell Function Indices and Sudomotor Function in Chinese Patients with Type 2 Diabetes

PURPOSE

SUDOSCAN, a new non-invasive, quick, sensitive and quantitative technique, has been developed to detect diabetic peripheral neuropathy, and the latter is believed to be correlated with impaired β-cell function. The purpose of the present study was to investigate the associations between β-cell function indices and sudomotor function in Chinese type 2 diabetes.

METHODS

A total of 266 Chinese patients with type 2 diabetes were enrolled. Sudomotor function was assessed using electrochemical skin conductance of hands and feet. Pancreatic β-cell function was determined by homeostasis model assessment of β-cell function index, early-phase β-cell function indices and total β-cell function indices. Pearson correlation analysis and multiple linear stepwise regression analysis were carried out to explore the associations between β-cell function indices and sudomotor function.

RESULTS

Patients with lower early-phase β-cell function had lower electrochemical skin conductance levels of hands and feet and higher asymmetry ratio of hands and feet. Both Pearson correlation analysis and multiple linear stepwise regression analysis showed significantly positive relationships between early-phase β-cell function and electrochemical skin conductance levels of hands and feet, after controlling for potential confounders (P<0.05).

CONCLUSIONS

Impaired early-phase β-cell function was positively associated with sudomotor dysfunction in Chinese patients with type 2 diabetes. We speculated that impaired early-phase β-cell function may be associated with the incidence of sudomotor dysfunction in patients with T2DM.

Development of clinical risk models for diabetic cardiovascular autonomic neuropathy in a Chinese population using logistic regression analysis

Background: We developed clinical risk models for predicting diabetic cardiovascular autonomic neuropathy (DCAN) in Chinese diabetic patients.

Methods: A Chinese cohort of 455 diabetic participants underwent a short heart rate variability (HRV) test which was recruited between 2011 and 2013. Clinical risk models were developed that included independent and significant risk factors by using multiple variable stepwise regressions. These clinical risk models were tested in another independent cohort of Chinese individuals.

Results: The clinical risk models included age, fasting plasma glucose, 2-h plasma blood glucose, triglycerides, resting HRs, and duration of diabetes mellitus. The area under the receiver-operating characteristic (ROC) curve of the study group was 0.794. In the model with the continuous variables, the area under the ROC curve was 0.810. A cutoff score of 12.54 which produced the optimal sensitivity (68.20%) and specificity (76.80%) and identified the percentage (35.77%) of the population that required subsequent testing.

Conclusions: The clinical risk models showed high sensitivity and specificity for the prediction of DCAN in Chinese diabetic patients.

Analysis of a Screening System for Diabetic Cardiovascular Autonomic Neuropathy in China

Background

The aim of this study was to create a screening system for diabetic cardiovascular autonomic neuropathy (DCAN) in diabetic patients.

Material/Methods

A Chinese cohort of 455 diabetic participants was recruited between 2011 and 2013. Short-term heart rate variability testing was used to evaluate cardiovascular autonomic function. A simple model was developed using multiple variable regression to include only significant risk factors that were simple and easily assessed. A DCAN score was determined based on the coefficients of the multiple variable model. This score was tested on the entire cohort of 455 diabetic patients and another independent, external cohort of 115 diabetic patients.

Results

The screening system consisted of age, body mass index, duration of diabetes mellitus, and resting heart rate, and these factors were significantly (P<0.05) associated with DCAN. Receiver operating characteristic (ROC) curve analysis was done. The areas under the ROC curve were 0.798, 0.756, and 0.729 for the total sample, validation cohort, and external set, respectively. A cutoff DCAN score of 12 out of 25 produced optimal results for sensitivity (80.36%), specificity (58.27%), and percentage of patients that needed subsequent testing (43.55%) for the validation set.

Conclusions

The study concludes that a simple and practical DCAN screening can be applied for early intervention to delay or prevent the disease in the Chinese population.

Analysis of the association between glucose profiles and β-cell function for diabetic cardiovascular autonomic neuropathy in China

AIMS/INTRODUCTION

The purpose of the present study was to investigate the severity of glucose profiles and β-cell function associated with diabetic cardiovascular autonomic neuropathy (DCAN) in a Chinese sample.

MATERIALS AND METHODS

A community-based, cross-sectional study to analyze the risk factors of DCAN was carried out with 455 individuals recruited from a Chinese population. The glucose profile risk score was calculated to identify the association between the severity of the glucose profiles and DCAN. The associations of the severity of the glucose profiles and β-cell function with DCAN were analyzed using multivariable logistic regression.

RESULTS

Univariate analysis showed that the glucose profiles and homeostatic model assessment of insulin resistance were significantly associated with the DCAN outcome, respectively. Multivariable logistic regression showed that significant associations exist between glucose profile indices and DCAN, after controlling for potential confounding factors (P < 0.01 for all) in both models. Multivariable logistic regression also showed that parameters of β-cell function were associated with the DCAN outcome in the category model (P < 0.1 for all). The glucose profile risk score was independently and significantly associated with the DCAN outcome after controlling for confounding factors (P < 0.001 and P for a trend <0.001).

CONCLUSIONS

Our observations suggest that parameters of glucose profile indices and β-cell function are significantly and independently associated with DCAN, respectively. There was a tendency toward increased glucose profile risk score with increasing prevalence of DCAN.