Identification and performance of multiple clinical and laboratorial risk factors for diagnosis of cardiac autonomic neuropathy in type 1 diabetes patients

Cinthia Minatel Riguetto; Caroline Rigoleto Takano; Sharon Nina Admoni; Maria Candida Ribeiro Parisi; Maria Lucia Correa Giannella; Elizabeth João Pavin; Arnaldo Moura Neto

doi:10.1007/s40200-019-00467-2

Identification and performance of multiple clinical and laboratorial risk factors for diagnosis of cardiac autonomic neuropathy in type 1 diabetes patients

J Diabetes Metab Disord. 2019 Nov 22;18(2):565-573. doi: 10.1007/s40200-019-00467-2. eCollection 2019 Dec.

Authors

Cinthia Minatel Riguetto¹, Caroline Rigoleto Takano¹, Sharon Nina Admoni², Maria Candida Ribeiro Parisi¹, Maria Lucia Correa Giannella², Elizabeth João Pavin¹, Arnaldo Moura Neto¹

Affiliations

¹ 1Endocrinology Division, Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126 Campinas, São Paulo, 13084-971 Brazil.
² 2Serviço de Endocrinologia e Metabologia do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo Brazil.

Abstract

Purpose: The incidence of cardiac autonomic neuropathy (CAN) in patients with type 1 diabetes (T1D) is frequently underestimated. Individuals with T1D and CAN have an increased mortality risk, mainly from cardiovascular causes. The objectives of the present study were to assess the clinical and laboratory characteristics associated with CAN in patients with T1D and verify the ability of multiple clinical factors to help identify patients with this condition.

Methods: 102 patients with T1D were evaluated for CAN using standardized cardiovascular reflex testing. Clinical characteristics were used to compute a numerical score for CAN diagnosis and a ROC curve elaborated for assessment of the best cutoff to predict CAN. This score was then applied to the second sample of 120 patients. The sensitivity, specificity, and positive and negative predictive values were calculated.

Results: Prevalence of CAN was around 35% in the first sample of patients and just below 20% in the second sample. Hypertension, total cholesterol, triglycerides, postprandial sweating, diastolic blood pressure, abnormal right and left 10 g monofilament, retinopathy, and nephropathy were considered independent predictors of CAN. The CAN-score cut-off was 16.88. This yielded a sensitivity of 50%, specificity 73.8%, positive predictive value 22.9%, and negative predictive value 90.5%.

Conclusion: The use of a subset of clinical and laboratory characteristics can be more accessible than the cardiac reflex tests and more accurate than a single isolated characteristic.

Keywords: Cardiac autonomic neuropathy; Cardiovascular reflex test; Heart rate variability; Type 1 diabetes.