REVERSIBLE CARDIOVASCULAR AUTONOMIC FUNCTION IN DIABETES

R.Murlidharan,A.Chanda and R.J.Dash, Dept. Endocrinology, PGIMER, Chandigarh.

Aim: (i) To assess cardiovascular autonomic functions in uncontrolled diabetes mellitus and (ii) assess the reversibility of any dysfunction after 3 months of glycemic control.

Method: 15 patients of recent onset type 1 diabetes and 15 patients of type 2 diabetes with secondary suylfonyurea failure were studied in a state of uncontrolled hyperglycemia and 3 months after good glycemic control with intensive insulin therapy.  The standard Ewing’s battery of 5 cardiovascular tests was used.

Results: The mean pretreatment HbA, was 10.0±1.5% which decreased to 9.08±1.01% after 3 months intensive insulin therapy.  Abnormal Valsalva ratio was seen in 3 patients (10%) at baseline which persisted post-treatment(10%), abnormal HR variation with respiration in 4 (13.3%) which improved in 2 (6.6%), abnormal BP response to handgrip in 1 (3.3%) which persisted (3.3%) abnormal HR variation on, standing in 2 (6.6%) improvement in 1(3.3%) which persisted postreatment.  Overall 8(26.6%) qualified for diagnosis of cardiovascular autonomic neuropathy at baseline of whom 3 normalised after 3 months.  No patient deteriorated from normal or borderline status to abnormal.   No correlation was noted between baseline HbA, age, mean duration of diabetes and autonomic dysfunction.

Conclusion: Early cardiovascular autonomic dysfunction in diabetes mellitus is reversible by adequate glycemic control.