Cardiovascular autonomic neuropathy can be reversed in type 2 diabetes
medwireNews: Cardiovascular autonomic neuropathy (CAN) is reversible in people with type 2 diabetes, report Korean researchers who found that age was the most important predictor of recovery.
Other factors significantly associated with CAN recovery included lower glycated hemoglobin (HbA1c) levels and bodyweight, absence of concurrent albuminuria, and a shorter duration of diabetes.
“Therefore, careful monitoring for CAN in relatively young patients with type 2 diabetes and intensive glycemic control with lifestyle modifications could facilitate rapid CAN recovery,” write Jae Hyeon Kim (Sungkyunkwan University School of Medicine, Seoul) and co-authors in Cardiovascular Diabetology.
The researchers found that during 2–3 years of follow-up, 29.9% of 759 individuals with type 2 diabetes and CAN, but no history of cardiovascular disease, experienced CAN recovery.
The majority (93.8%) of recoveries involved a change from early (one abnormal parasympathetic test of three) to normal status, while 4.0% changed from definite (two or more abnormal parasympathetic tests) or severe (definite plus orthostatic hypotension) to normal. The remainder improved from definite or severe to early status.
The investigators observed that patients who recovered from definite or severe CAN to normal status were significantly younger than those who only achieved early status or who changed from early to normal status, at a mean of 41.6 versus 49.5 and 53.8 years, respectively.
Furthermore, on multivariate analysis adjusted for potential confounders, each 5-year decrease in patient age was associated with a significant 49% increase in the likelihood for recovery.
The likelihood for recovery also increased by 33% with each 5-year decrease in diabetes duration, by 32% with each 1% reduction in HbA1c, and by 11% with each 1-kg decrease in bodyweight.
By contrast, the probability of CAN recovery was a significant 66% lower for patients with micro- or macroalbuminuria relative to those with normoalbuminuria.
In an analysis of the relative significance of each of the factors associated with CAN recovery, age accounted for approximately 70% of the association, followed by HbA1c reduction (13%), diabetes duration (11%), bodyweight (3%), and lack of micro- or macroalbuminuria (3%).
Kim et al conclude: “Further evidence is needed to clarify the causality of the associations among these factors and CAN recovery, as well as the optimal duration of CAN monitoring.”
By Laura Cowen
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