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Autonomic neuropathy is associated with impairment of dynamic cerebral autoregulation in type 1 diabetes.
MedLine Citation:
PMID:  21036672     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
HYPOTHESIS: The mechanisms underlying impairment of dynamic cerebral autoregulation in diabetes are not well known. Cardiovascular autonomic neuropathy (CAN) could contribute to dynamic cerebral autoregulation impairment. In this study, we assessed the association between CAN and impairment of dynamic cerebral autoregulation in patients with type 1 diabetes.
METHODS: We evaluated dynamic cerebral autoregulation (DCA) in patients with type 1 diabetes and no history of cerebrovascular disease. DCA was assessed with transcranial Doppler using the correlation coefficient index Mx method. Mx was calculated from slow changes in mean cerebral blood flow velocity and mean arterial blood pressure. Increase in Mx indicates weaker DCA, with a threshold for impaired DCA above 0.3. Moderate CAN was defined as reduced heart rate variability (HRV) on the following tests: deep controlled breathing, Valsalva maneuver or initiation of active standing. Severe CAN was defined as reduced HRV associated with orthostatic hypotension.
RESULTS: 60 patients were included (M/F: 33/27; mean age±SD: 46years±11.5). 23 patients had moderate CAN and 15 patients severe CAN. DCA was impaired in 37 patients. CAN was associated with impaired DCA (p=0.005). Impairment of DCA was more pronounced in patients with severe CAN (p=0.019). Glycosylated haemoglobin (HbA1c) was associated with impaired DCA in univariate analysis (p=0.05). In multivariate analysis, only CAN was associated with impaired DCA (p=0.007) whereas HbA1c was not (p=0.161).
CONCLUSIONS: CAN was associated with impaired DCA in type 1 diabetes. The magnitude of DCA impairment increased with the severity of CAN.
Authors:
N Nasr; M Czosnyka; F Arevalo; H Hanaire; B Guidolin; V Larrue
Publication Detail:
Type:  Journal Article     Date:  2010-10-30
Journal Detail:
Title:  Autonomic neuroscience : basic & clinical     Volume:  160     ISSN:  1872-7484     ISO Abbreviation:  Auton Neurosci     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909359     Medline TA:  Auton Neurosci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  59-63     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier B.V. All rights reserved.
Affiliation:
Service de Neurologie Vasculaire, Hôpital Rangueil, Toulouse, INSERM U858, Team 09, IFR31, Toulouse, France.
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