Relationship between Peripheral Neuropathy and Cardiovascular Autonomic Neuropathy in Non-Insulin Dependent Diabetics

Ha, Sung Woo; Lee, Hyun Jeong; Han, Jeung Hun; Jung, Sang Won; Nam, Jick Hwa; Sin, Byoung Ho; Koo, Seong Mo; Kim, Jung Guk; Kwon, Sam; Kim, Bo Wan

Abstract

BACKGROUND: Autonomic neuropathy was detected in some diabetics with symmetric peripheral neuropathy, a common complication of diabetes mellitus that may be associated with considerable morbidity. There has been known to be similarity of pathogenic mechanism in two neuropathies. Then we examined nerve conduction velocity and cardiovascular autonomic function tests. We studied relationship between peripheral and cardiovascular autonomic neuropathy in non-insulin dependent diabetics.
METHODS
We studied 166 patients with or witbout peripheral neuropathy who had been diagnosed as non-insulin dependent diabetes mellitus. We examined nerve conduction tests to assess diabetic peripheral neuropathy and classified them into 4 groups aecording to neuropathic symptoms and results of nerve conduction tests. We examined five cardiovascular autonomic function tests by Ewing's methods.
RESULTS
1. The duration of diabetes mellitus was significantly longer in the group of cliabetics with neuropathic symptoms and abnormal findings in the nerve conduction velocity tests than the other groups. The level of blood glucose was significantly higher in the group of diabetics with neuropathic symptoms and findings than the other groups. 2. In the 5 cardiovascular autonomic function tests, heart rate response to deep breathing and Valsalva maneuver had significant differences between the diabetic group with peripheral neuropathy and the other groups. 3. The frequency and severity of autonomic neuropathy were higher in the group with peripheral neuro-pathic symptoms and findings than the other groups without neuropathic syrnptoms and findings. There was an overall significant relationship between sensorirnotor neural function and autonomic function. 4. There was no association between peripheral neuropathy and nephropathy although peripheral neuropathy was related with retinopathy.
CONCLUSION
Diabetic peripheral neuropathy accompanies autonomic neuropathy. Then, this result suggests that there is the relationship between peripheral and cardiovascular autonomic neuropathy.