A clinical study of cardiac autonomic neuropathy with retinopathy and nephropathy in patients with type 2 diabetes mellitus

Abstract:

Objective To investigate the prevalence of cardiac autonomic neuropathy（CAN） with retinopathy and nephropathy in patients with type 2 diabetes mellitus（T2DM） and associated risk factors.Methods A total of 203 patients with T2DM who were hospitalized in the Department of Endocrinology of The First People’s Hospital of Yunnan Province from May 2022 to May 2023 were included. CAN was determined based on the scores of cardiovascular autonomic reflex tests. According to the presence or absence of diabetic retinopathy（DR） and diabetic kidney disease（DKD），the patients with CAN were divided into CAN alone group，CAN+DR group，CAN+DKD group，and CAN+DR+DKD group. The clinical data of all subjects were collected for statistical analysis using SPSS 26.0 software.Results Among the 203 patients with T2DM，the prevalence rate of CAN was 58.62%，with the prevalence rate of CAN+DR，CAN+DKD，CAN+DR+DKD being 10.08%，7.56%，and 10.92%，respectively. There were significant differences between the four groups in age，glycosylated hemoglobin（HbA1c），estimated glomerular filtration rate（eGFR），lactate dehydrogenase（LDH），direct bilirubin（DBIL），and the amount of time for blood glucose levels in the target range over 72 hours（TIR）（P<0.05）. The logistic regression analysis showed that HbA1c（odds ratio［OR］=2.948，95%CI=1.015-8.560，P=0.047） and LDH（OR=1.151，95%CI=1.035-1.280，P=0.010） were factors promoting the development and progression of CAN with DR and DKD； and DBIL（OR=0.057，95%CI=0.005-0.658，P=0.022），eGFR（OR=0.700，95%CI=0.513-0.955，P=0.025），TIR（OR=0.877，95%CI=0.775-0.992，P=0.037），and age（OR=0.550，95%CI=0.349-0.868，P=0.010） were significantly associated with the development and progression of CAN with DR and DKD.Conclusion Lower eGFR，TIR，DBIL，and age are negatively correlated with the occurrence of CAN with DR and DKD，while higher HbA1c and LDH are positively correlated with the occurrence of CAN with DR and DKD. Therefore，more attention should be paid to screening for CAN with DR and DKD in patients with T2DM with low eGFR，TIR，DBIL，age and/or high HbA1c and LDH.