Otonom Diyabetik Nöropati ile Glisemik Kontrol Arasındaki İlişki

Year 2017, Volume: 17 Issue: 4, 245 - 252, 20.12.2017

Gülşah Şahin Mustafa Reşat Dabak , Gülbüz Sezgin Can Dolapçıoğlu Emel Ahıskalı Oya Uygur Bayramiçli

https://doi.org/10.17098/amj.364159

Abstract

Amaç: Tip 2 diabetes mellituslu (DM)
hastalarda gastrointestinal ve kardiyovasküler diyabetik otonomik nöropatinin
değerlendirilmesi amaçlanmaktadır.

Materyal ve Metot: DM hastalarından
oluşan çalışma grubu Mart-Eylül 2012 tarihleri
arasında incelendi. Yaş, vücut kütle indeksi (VKİ), açlık kan glukozu, HbA1c,
C-peptid, diyabet süresi, elektrokardiyogram, kan basıncı, kalp hızı
kaydedildi. Hastalar kontrol altında olan ve olmayan diyabetikler olarak
gruplandırıldı. Kardiyak otonom nöropati (KON) testleri değerlendirildi. Anal
manometri ile rekto-anal inhibitör refleks, istirahat ve sıkma basınçları ölçüldü.

Bulgular: Toplam 50 DM hastası
çalışmaya kaydedildi ve hastaların yaş ortalaması 57,06±8,92 yıl, istirahat anal
basıncı ortalaması 55,92±14,84 mmHg ve sıkma anal basıncı ortalaması 83,15±31,00
mmHg idi. Orta ve ağır KON grupları arasında istirahat anal basıncında anlamlı
fark saptanmazken (p=0,573), orta ve ağır KON grupları arasında maksimum sıkma
basıncında anlamlı fark mevcuttu (p=0,005). Kısa veya uzun süreli diyabeti olan
hastalarda anal manometrik basınçlarda fark saptanmadı. KON ile VKİ arasında
ilişki bulunmazken yaş ile ilişki saptandı. Kötü glisemik kontrol istirahat
basında azalma ile ilişkili iken, maksimum sıkma basıncı ve yetersiz glisemik
kontrol grubu arasında ilişki yoktu. KON’un şiddeti maksimum sıkma basıncında
azalma ile ilişkiliydi.

Sonuç: Kardiyak ve gastrointestinal otonom
disfonksiyon, DM’nin önemli komplikasyonlarıdır. Anal manometri testleri ve KON diyabetin bu komplikasyonlarını gösterebilir. 

Keywords

Manometre, tip 2 diabetes mellitus, diyabetik otonom nöropati

Relationship Between Autonomic Diabetic Neuropathy and Glycemic Control

Abstract

Objectives: To assess
gastrointestinal and cardiovascular diabetic autonomic neuropathy in patients
with type 2 diabetes mellitus (DM).

Materials and Methods: The study group
composed of DM patients examined between March and September 2012. Age, body
mass index (BMI), fasting blood glucose, HbA1c, C–peptide, duration of
diabetes, electrocardiogram, blood pressure, heart rate were recorded.
Patients were grouped as controlled and
uncontrolled diabetics. Cardiac autonomic neuropathy (CAN) tests were
done. Rectoanal inhibitory reflex, resting and squeeze pressures were measured
by anal manometry.

Results: A
total of 50 DM patients were enrolled and the
mean age of patients was 57.06±8.92 years, the mean resting anal pressure was
55.92±14.84 mmHg, and squeezing anal pressure was 83.15±31.00 mmHg. There was no significantly different resting anal
pressure between mild and severe CAN groups (p=0.573), but maximum
squeezing pressure was significantly different between mild and severe CAN groups (p=0.005). Anal manometric pressures
were not different in patients with short or long duration of diabetes. BMI was
not associated with CAN, whereas age was. Bad glycemic control was associtated
with a decrease in resting pressures, but no significant difference between
maximum squeeze pressures and insufficient glycemic control groups. Severity of
CAN was associated with a decrease in maximum squeeze pressures.

Conclusion: Cardiac and
gastrointestinal autonomic dysfunction are
important complications of DM. Anal
manometric tests and CAN may show these complications of diabetes. 

Keywords

Manometry, type 2 diabetes mellitus, diabetic autonomic neuropathy

References

• 1. Grundy SM, Benjamin IJ, Burke GL et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999;100(10):1134–46.
• 2. Brock C, Brock B, Pedersen AG, Drewes AM, Jessen N, Farmer AD. Assessment of the cardiovascular and gastrointestinal autonomic complications of diabetes. World J Diabetes 2016;7(16):321-32.
• 3. Sundkvist G, Lilja B. Autonomic neuropathy predicts deterioration in glomerular filtration rate in patients with IDDM. Diabetes Care 1993;16:773–9.
• 4. Goff DC Jr, Gerstein HC, Ginsberg HN, Cushman WC, Margolis KL, Byington RP, et al. Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am J Cardiol 2007;18:4-20.
• 5. Wheeler SG, Ahroni JH, Boyko EJ. Prospective study of autonomic neuropathy as a predictor of mortality in patients with diabetes. Diabetes Res Clin Pract 2002;58:131-8.
• 6. Veglio M, Carpano-Maglioli P, Tonda L et al. Autonomic neuropathy in non-insulin-dependent diabetic patients: correlation with age, sex, duration and metabolic control of diabetes. Diabete Metab 1990;16 (3):200-6.
• 7. Murray DP, O'Brien T, Mulrooney R, O'Sullivan DJ. Autonomic dysfunction and silent myocardial ischaemia on exercise testing in diabetes mellitus. Diabet Med 1990;7(7):580-4.
• 8. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes. Diabetes Care 1985;8:5:491-8.
• 9. DCCT Research Group. The effect of intensive diabetes therapy onmeasures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia 1998;41:416-23.
• 10. Kennedy WR, Navarro X, Sutherland DE. Neuropathy profile of diabetic patients in a pancreas transplantation program. Neurology 1995;45:773-80.
• 11. Pappachan JM, Sebastian J, Bino BC et al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgrad Med J 2008;84(990):205-10.
• 12. Tentolouris N, Katsilambros N, Papazachos G et al. Corrected QT interval in relation to the severity of diabetic autonomic neuropathy. Eur J Clin Invest 1997;27:1049-54.
• 13. Cerutti F, Rabbia F, Rabbone I, Bobbio A, Ignaccolo MG, Greco G, et al. Impairment of cardiovascular autonomic pattern in obese adolescents with Type 2 diabetes mellitus. J Endocrinol Invest 2010;33(8):539-43.
• 14. Valensi P, Paries J, Attali JR. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications-the French multicenter study. Metabolism 2003;52(7):815-20.
• 15. Chen HS, Hwu CM, Kuo BI, Chiang SC, Kwok CF, Lee SH, et al. Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes mellitus. Diabet Med 2001;18(4):268-73.
• 16. Thi NN, Paries J, Attali JR, Valensi P. High prevalence and severity of cardiac autonomic neuropathy in Vietnamese diabetic patients. Diabet Med 2005;22(8):1072-8.
• 17. Katusic ZS, Vanhoutte PM. Superoxide anion is an endothelium-derived contracting factor. Am J Physiol 1989;257(1Pt2):H33-7.
• 18. Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ, O'Brien PC. Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 1999;22(9):1479-86.
• 19. Maleki D, Camilleri M, Burton DD et al. Pilot study of pathophysiology of constipation among community diabetics. Dig Dis Sci. 1998;43:2373–8.
• 20. Schiller LR, Santa Ana CA, Schmulen AC, Hendler RS, Harford WV, Fordtran JS. Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. N Engl J Med 1982;307:1666–71.
• 21. Deen KI, Premaratna R, Fonseka MM, De Silva HJ. The recto-anal inhibitory reflex: abnormal response in diabetics suggests an intrinsic neuroenteropathy. J Gastroenterol Hepatol 1998;13(11):1107-10.
• 22. Rogers J, Levy DM, Henry MM, Misiewicz JJ. Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut 1988;29(6):756–61.
• 23. Russo A, Botten R, Kong MF, Chapman IM, Fraser RJ, Horowitz M, et al. Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitus. Diabet Med 2004;21(2):176-82.