Biomedical papers, 2016 (vol. 160), issue 1

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016, 160(1):111-117 | 10.5507/bp.2015.063

The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up

Silvie Lacigova, Jitka Brozova, Daniela Cechurova, Jitka Tomesova, Michal Krcma, Zdenek Rusavy
Department of Internal Medicine I, University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic

Aim: The aim of our retrospective study was to answer the question if the presence of cardiovascular autonomic neuropathy (CAN) affects mortality in type 1 diabetic patients during a 10-year follow-up.

Methods: Patients with type 1 diabetes mellitus examined for CAN in 2003 were enrolled in this retrospective study. A total of 278 patients were included and divided into two groups according to the presence or absence of CAN (111 CAN+, 167 CAN-). The group characteristics and outcomes were compared at baseline and after ten years (in 2013).

Results: In the follow-up period, a total of 18 patients died; CAN+ (14/111; 12.6%) and CAN- (4/167; 2.4%) (P < 0.001). At baseline, the CAN+ patients were older (47 vs. 33 years; P < 0.001), had longer duration of diabetes (20 vs. 12 years; P < 0.05), had worse glycemic control assessed by HbA1c (73 vs. 68 mmol/mol; P < 0.05), higher systolic (130 vs. 120 mmHg; P < 0.001) and diastolic (80 vs. 70 mmHg; P < 0.01) blood pressure and had more diabetic complications. In our analysis we found the strongest predictor of mortality to be the presence of CAN (P < 0.01) and the blood pressure value at baseline (P < 0.05). Other baseline characteristics, including the duration of diabetes, age and the presence of micro- and macrovascular complications were not significant. The statistical analysis was performed using logistic regression step-wise analysis.

Conclusions: During the 10-year follow-up, CAN+ patients had a 5-fold higher mortality rate than CAN- patients. The strongest predictor of mortality was the presence of CAN.

Keywords: type 1 diabetic patients, cardiovascular autonomic neuropathy, chronic complications, morbidity, mortality

Received: February 26, 2015; Accepted: December 2, 2015; Prepublished online: January 5, 2016; Published: March 30, 2016


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