Cardiac Autonomic Neuropathy in Diabetic Patients in Kirkuk General Hospital
Background: Cardiac autonomic neuropathy (CAN) in diabetic patients is defined as the
impairment of cardiovascular autonomic control in patients with established diabetes
mellitus (DM) following the exclusion of other causes. It is one of the least recognized and
understood complications of diabetes despite its significant negative impact on survival
and quality of life. CAN, especially at the early stages, can be sub-clinical and thus as the
disease progresses, it becomes clinically evident.
Objectives: to evaluate the CAN by using bedside clinical tests of cardiac autonomic
function in diabetic patients and to correlate CAN with duration of diabetes, prolonged QTc
interval and other microvascular complications.
Methods: A study including 90 diabetic patients who attend outpatient clinic or admitted to
medical ward in Kirkuk General Hospital from March to September 2015. Tests of cardiac
autonomic function were done for all patients. Automated corrected QT (QTc) intervals
were obtained from ECG recorded data paper.
Results: A total of 90 diabetic patients were included in this study which revealed females
(59%) predominance over males (41%). Type 1 DM was found in 20 patients (22.2%)
while the remaining 70 patients (77.8%) were type 2 DM. CAN was presents in twenty five
patients (27.8%). Symptoms that related to CAN with statistical significance were
palpitation, dyspepsia (gastroparesis), sweating and silent myocardial infarction or
ischemia. Regarding the five clinical tests that be used to determine CAN in this study, the
heart rate variation to deep breathing was the most frequent abnormal test, it was
abnormal in 16 (64%) patients within CAN group. This was followed by abnormal Valsalva
maneuver, which was abnormal in 10 (40%) patients. Resting tachycardia was present in
9 (36%) patients. The less frequent tests to detect CAN were abnormal hand grip
response and postural hypotension, as 28% and 24%, respectively. Moreover, diabetic
patients with CAN had statistically significant QTc prolongation (88%) as compared to
diabetic patients without CAN (7.7%).
Conclusions: CAN is a common complication of diabetes mellitus. CAN is significantly
correlated to long duration of diabetes, prolonged QTc interval and other microvascular
Keywords: Cardiac autonomic neuropathy, Kirkuk, QTc interval, Diabetes mellitus.
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