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Clinical significance of autonomic neuropathy in type 1 diabetic patients

To investigate clinical significance of autonomic neuropathy as a predictive factor for the development of retinopathy in 118 normotensive and normoalbuminuric patients, autonomic tests based on standard, vector and spectral analysis of heart rate variation (HRV) and 24 h blood pressure (BP) measurement were performed. Incidence of autonomic neuropathy ( 9, 5 +/- 5, 5 ; 59, 6%) was significantly higher in group of 43 patients with retinopathy in comparison with group of 75 patients without retinopathy (5.29 +/- 4.9 ; 16%), (p<0, 05). Patients were similar regarding age, sex, HbA1c, 24h urinary albumin excretion (UAE). Group of patients with retinopathy had significantly higer duration of diabetes. Maximal night systolic, mean night and day diastolic blood pressure was significantly higher in patients with retinopathy (116, 84 +/- 10 ; 63, 32 +/- 8, 1 ; 73, 3 +/- 7, 4) compared to patients without (114, 32 +/- 9, 1 ; 58, 72 +/- 7, 3 ; 70, 95 +/- 4, 6) (p=0, 03). Maximal night systolic BP was inversely related to power HF (r=-0, 28, p=0, 05) and CV deep breathing (r= -0, 23, p= 0, 02). Mean night diastolic BP was inversely related to power MF (r= -0, 21, p=0, 03), HF (r=-0, 32, p=0, 005), CV deep breathing (r=-0, 27, p=0, 005) and MCR deep breathing (r=-0, 24, p=0, 003) ; mean day diastolic BP to power HF (r=-0, 22, p=0, 02). In multiple regression analysis retinopathy was associated with the duration of diabetes (b=0.53) and autonomic neuropathy (b=0.28) (p<0.001). Autonomic neuropathy is related to BP elevation and retinopathy in normotensive and normoalbuminuric type 1 diabetic patients. We conclude, in order to predict the development of complications, autonomic testing should be routinely performed in type 1 diabetics at the normotensive and normoalbuminuric stage.

type 1 diabetes; autonomic neuropathy; retinopathy

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