Skip to main content
SpringerLink
Log in

Predicting cardiac autonomic neuropathy in type I (insulin-dependent) diabetes mellitus

  • Research Paper
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

A total of 24 subjects with type I insulin-dependent diabetes mellitus were studied. Cardiac parasympathetic function was measured by supine heart rate variability (HRV) in the respiratory frequency 0.10–0.50 Hz and the sympathetic index was measured as the ratio of HRV between 0.055 and 0.098 Hz to that between 0.004 and 0.5 Hz. Factors assessing diabetic control and complications, and factors unrelated to diabetes but possibly influencing HRV, were recorded. Association with depressed HRV was assessed with correlation, and prediction of depressed HRV was determined with multiple regression. Factors associated with depressed HRV but not independently predictive were renal dysfunction and elevated thyroid stimulating hormone. Elevated glycosylated haemoglobin was not significantly correlated with depressed HRV. Four factors (presence of diabetic retinopathy, male gender, duration of diabetes and increasing age) were significant in the regression and sufficed to predict 81% of the sample variance. The relative weights (β) were −0.65, 0.40, −0.40 and 0.26, respectively. Supine sympathetic index was not sufficient to demonstrate sympathetic dysfunction. It is proposed that the regression model may be used to identify patients likely to have cardiac parasympathetic autonomic dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Levy MN, Zieske H. Autonomic control of cardiac pacemaker activity and atrioventricular transmission.J Appl Physiol 1969;27: 465–470.

    PubMed  Google Scholar 

  2. Pomeranz B, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D, Kiborn KM, Barger AC, Shannon DC, Cohen RJ, Benson, H. Assessment of autonomic function in humans by heart rate spectral analysis.Am J Physiol 1985;248: H151–153.

    PubMed  Google Scholar 

  3. Jaffe RS, Fung DL, Behrman KH. Optimal frequency ranges for extracting information on autonomic activity from the heart rate spectrogram.J Auton Nerv Syst 1994;46: 37–46.

    PubMed  Google Scholar 

  4. Freeman R, Saul JP, Roberts MS, Berger RD, Broadbridge C, Cohen RJ. Spectral analysis of heart rate in diabetic autonomic neuropathy. A comparison with standard tests of autonomic function.Arch Neurol 1991;48: 185–190.

    PubMed  Google Scholar 

  5. Bernardi L, Luigi R, Lazzari P, Soldá P, Calciati A, Ferrari MR, Vandea I, Finardi G, Fratino P. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease.Circulation 1992;86: 1443–1452.

    PubMed  Google Scholar 

  6. Lindecrantz KG, Lilja H. New software QRS detector algorithm suitable for real time applications with low signal-to-noise ratios.J Biomed Eng 1988;10: 280–284.

    PubMed  Google Scholar 

  7. Berger RD, Akselrod S, Gordon D, Cohen RJ. An efficient algorithm for spectral analysis of heart rate variability.IEEE Trans Biomed Eng 1986;33: 900–904.

    PubMed  Google Scholar 

  8. Harris FJ. On the use of windows for harmonic analysis with the discrete fourier transform.Proc IEEE 1978;66: 51–83.

    Google Scholar 

  9. Freeman MF, Tukey JW. Transformations related to the angular and the square root.Ann Math Stat 1950;21: 607–611.

    Google Scholar 

  10. Navarro X, Kennedy WR, Ferrer MT. Cardiovascular responses to tilting in healthy and diabetic subjects.J Neurol Sci 1991;104: 39–45.

    PubMed  Google Scholar 

  11. Saul JP, Berger RD, Albrecht P, Stein SP, Chen MH, Cohen RJ. Transfer function analysis of the circulation: unique insights into cardiovascular regulation.Am J Physiol 1991;261: H1231–1245.

    PubMed  Google Scholar 

  12. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.JAMA 1988;260: 2864–2871.

    PubMed  Google Scholar 

  13. Chase HP, Jackson WE, Hoops SL, Cockerham RS, Archer PG, O'Brien D. Glucose control and the renal and retinal complications of insulin-dependent diabetes.JAMA 1989;261: 1155–1160.

    PubMed  Google Scholar 

  14. Piha SJ. Cardiovascular autonomic reflex tests: normal responses and age-related reference values.Clin Physiol 1991;11: 277–290.

    PubMed  Google Scholar 

  15. The DCCT Research Group. Factors in development of diabetic neuropathy. Baseline analysis of neuropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT).Diabetes 1988;37: 476–481.

    Google Scholar 

  16. Vondrová H, Bartos V, Skibová J. Nekteré faktory ovlivnující vyskyt a tízi polyneuropatie u diabetu mellitu I. typu. [Factors affecting the incidence and severity of polyneuropathy in type I diabetes mellitus]Cas Lék Cesk 1990;129: 1004–1008.

    Google Scholar 

  17. Axelrod S, Lishner M, Oz O, Bernheim J, Ravid M. Spectral analysis of fluctuations in heart rate: an objective evaluation of autonomic nervous control in chronic renal failure.Nephron 1987;45: 202–206.

    PubMed  Google Scholar 

  18. McKenna MJ, Herskowitz R, Wolfsdorf JI. Screening for thyroid disease in children with IDDM.Diabetes Care 1990;13: 801–803.

    PubMed  Google Scholar 

  19. Dillmann WH. Diabetes and thyroid-hormone-induced changes in cardiac function and their molecular basis.Annu Rev Med 1989;40: 373–394.

    PubMed  Google Scholar 

  20. Goldman M, Dratman MB, Crutchfield FL, Jennings AS, Maruniak JA, Gibbons R. Intrathecal triiodothyronine administration causes greater heart rate stimulation in hypothyroid rats than intravenously delivered hormone. Evidence for a central nervous system site of thyroid hormone action.J Clin Invest 1985;76: 1622–1625

    PubMed  Google Scholar 

  21. McNeill JH. 1983 Upjohn Award lecture. Endocrine dysfunction and cardiac performance.Can J Physiol Pharmacol 1985;63: 1–8.

    PubMed  Google Scholar 

  22. Neil HAW, Thompson AV, John S, McCarthy ST, Mann JI. Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population.Diabetic Med 1989;6: 20–24.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of California Davis, TB 170, 95616, Davis, CA, USA

    R. S. Jaffe MD, P. L. Rohatsch RN, E. A. Disbrow MA & D. L. Fung MD

  2. Department of Endocrinology, University of California Davis, TB 170, 95616, Davis, CA, USA

    T. T. Aoki MD

Authors
  1. R. S. Jaffe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. T. Aoki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. L. Rohatsch RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. A. Disbrow MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. L. Fung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaffe, R.S., Aoki, T.T., Rohatsch, P.L. et al. Predicting cardiac autonomic neuropathy in type I (insulin-dependent) diabetes mellitus. Clinical Autonomic Research 5, 155–158 (1995). https://doi.org/10.1007/BF01826198

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01826198

Keywords

Search

Navigation