Diagnosis of the cardiac autonomic neuropathy in diabetic patient


  • Shuper V. A. Bucovinian State Medical University, Chernivtsi, Ukraine
  • Shuper S. V. Yuriy Fedkovych Chernivtsi National University, Chernivtsi, Ukraine
  • Rykova Ju. O. Kharkiv National Medical University, Kharkiv, Ukraine
  • Trefanenko I. V. Bucovinian State Medical University, Chernivtsi, Ukraine
  • Shumko G. I. Bucovinian State Medical University, Chernivtsi, Ukraine
  • Reva T. V. Bucovinian State Medical University, Chernivtsi, Ukraine




cardiac autonomic neuropathy, Diabetes Mellitus, diagnosis


Cardiac autonomic neuropathy (CAN) is a very common diabetes-related complication that has a major effect on CVD, mortality and morbidity in patients with DM. Careful and timely testing of CAN with easy standard bedside tests in patients with DM 1 and 2 is critically important for early diagnoses and prophylaxes of further CV complications. Aim of the study was to evaluate the CAN characteristics in DM 1 versus DM 2 patients and to identify the relationship between CAN and typical diabetic complications. Materials and methods. A descriptive and comparative cross-sectional study was developed with 75 patients with Diabetes Mellitus (DM 1 — 30 patients, DM 2 — 45 patients) who were hospitalized to the endocrinology department for treatment. All patients were investigated routinely – complains, anamnestic data, objective examination, lab and instrumental examination. For defining of CAN next five classical tests were done (cardiac autonomic reflex testing (CART)): Evaluating of the Resting tachycardia; Heart rate response to deep breathing; Valsalva maneuver; Systolic blood pressure response to standing; Diastolic blood pressure response to sustained handgrip. Results and discussions. Absence of CAN, according to proposed score, was defined in those patients without clinical features of CVD. 46.8% of all patients presented with early and definitive CAN, while the higher prevalence of definitive CAN was diagnosed in DM 2 patients. Severe CAN was confirmed more often in DM 2 patients also. Coexistence of CAN and peripheral neuropathy was higher in patients with DM 1 than in DM 2 patients. Among DM 1 patients with CAN only 11.8% persons had not sensory peripheral neuropathy, while 29.7% DM 2 patients with CAN, were free of sensory peripheral neuropathy. Positive correlations were found between the duration of the DM and manifestations of CAN in patients with DM II, the development of sensory polyneuropathy, retinopathy and CAN in patients with DM I, and this diabetic complication preceded the clinical manifestations of peripheral neuropathy. Thus, the proposed set of diagnostic measures should be obviously and easily used for the timely diagnosis of CAN in diabetic patients, especially in asymptomatic cases, and objectively assessing the effectiveness of the therapy.


World Health Organization. Global Report on Diabetes. 2016, available at: http://www.who.int/diabetes/globalreport/en/ on 08.29.2017.

International Diabetes Federation. Atlas, 7th Ed, available at: http://www.diabetesatlas.org/across-the-globe.html on 08.29.2017.

Matheus AS, Tannus LR, Cobas RA, et al. Int J Hypertens 2013; 2013: 653789. https://doi.org/10.1155/2013/653789.

Leon BM, Maddox TM. World J Diabetes 2015; 6(13): 1246-1258. https://doi.org/10.4239/wjd.v6.i13.1246.

Vinik AI, Casellini C, Parson HK, et al. Front Neurosci 2018; 12: 591. https://doi.org/10.3389/fnins.2018.00591.

Dyck PJ, Albers JW, Andersen Н, et al. Diabetes Metab Res Rev 2011; 27: 620-628. https://doi.org/10.1002/dmrr.1226.

Spallone V, Ziegler D, Freeman R, et al. Diabetes Metab Res Rev 2011; 27(7): 639-653. https://doi.org/10.1002/dmrr.1239.

Pop-Busui R, Boulton AJ, Feldman EL. Diabetes Care 2017; 40: 136-154. https://doi.org/10.2337/dc16-2042.

Fisher VL, Tahrani АА. Diabetes, metabolic syndrome and obesity: targets and therapy 2017; 10: 419-434. https://doi.org/10.2147/DMSO.S129797.

Rolim LC, de Souza JS, Dib SA. Front Endocrinol 2013; 4: 173. https://doi.org/10.3389/fendo.2013.00173.

Serhiyenko VA, Serhiyenko АА. World J Diabetes 2018; 9(1): 1-24. https://doi.org/10.4239/wjd.v9.i1.1.

Bernardi L, Spallone V, Stevens М. Diabetes Metab Res Rev 2011; 27: 654-664. https://doi.org/10.1002/dmrr.1224.

Tang ZH, Zeng F, Li Z, Zhou L. J Diabetes Res 2014; 2014: 215473. https://doi.org/10.1155/2014/215473.

Balcıoğlu AS, Müderrisoğlu Н. World J Diabetes 2015; 6(1): 80-91. https://doi.org/10.4239/wjd.v6.i1.80.

Menon AS, Dixit A, Garg MK, Girish R. Indian J Endocrinol Metab 2017; 21(2): 282-285. https://doi.org/10.4103/ijem.IJEM_542_16.

Arif ZA, Shaikh IА, Masood N. Indian Heart J 2014; 66(6): 751-754. https://doi.org/10.1016/j.ihj.2014.10.417.

Dafaalla MD, Nimir MN, Mohammed MI. Open Heart 2016; 3: e000336. https://doi.org/10.1136/openhrt-2015-000336.

Andersen ST, Witte DR, Fleischer J, et al. Diabetes Care 2018; 41(12): 2586-2594. https://doi.org/10.2337/dc18-1411.




How to Cite

Shuper, V. A., Shuper, S. V., Rykova, J. O., Trefanenko, I. V., Shumko, G. I., & Reva, T. V. (2019). Diagnosis of the cardiac autonomic neuropathy in diabetic patient. Problems of Endocrine Pathology, 69(3), 91-97. https://doi.org/10.21856/j-PEP.2019.3.12