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Published online May 28, 2008
Diabetes Care 31:1832-1836, 2008
DOI: 10.2337/dc08-0682
© 2008 by the American Diabetes Association
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Pathophysiology/Complications
Original Research

Progression of Cardiovascular Autonomic Dysfunction in Patients With Type 2 Diabetes

A 7-year follow-up study

Seung-Hyun Ko, MD, PHD1, Shin-Ae Park, MD1, Jae-Hyoung Cho, MD, PHD1, Ki-Ho Song, MD, PHD1, Kun-Ho Yoon, MD, PHD1, Bong-Yun Cha, MD, PHD1, Ho-Young Son, MD, PHD1, Ki-Dong Yoo, MD, PHD2, Keon-Woong Moon, MD, PHD2, Yong-Moon Park, MD, PHD3 and Yu-Bai Ahn, MD, PHD1

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
2 Department of Cardiology, The Catholic University of Korea, Seoul, Korea
3 Department of Preventive Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Yu-Bai Ahn, ybahn{at}catholic.ac.kr

OBJECTIVE—We investigated whether cardiovascular autonomic dysfunction was associated with glycemic control status over time in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—From 1999 to 2000, cardiovascular autonomic nerve function testing (AFT) was performed on patients with type 2 diabetes (n = 1,021) and was followed-up in 2006 and February 2008. Tests for cardiovascular autonomic functions measured heart rate variability parameters (expiration-to-inspiration [E/I] ratio, responses to the Valsalva maneuver, and standing). AFT scores were determined from the results of the each test as follows: 0 for normal and 1 for abnormal. We began with those who had a score of 0 and assessed the changes in total score along with biannual A1C levels.

RESULTS—At follow-up, the development of cardiovascular autonomic dysfunction was 34.5% (E/I ratio 21.9%, Valsalva maneuver 77.8%, and posture 58.9%; n = 783). The development of cardiovascular autonomic dysfunction was higher in older patients (P < 0.001); in those with longer duration of diabetes (P < 0.001); of hypertension (P = 0.005), and of diabetic retinopathy (P < 0.001); and in those who had higher levels of microalbuminuria (P = 0.002). Logistic regression analysis revealed that the development of cardiovascular autonomic dysfunction was strongly associated with the mean A1C level during the follow-up period (mean A1C >9.0% vs. ≤7.0%, odds ratio 2.984, 95% CI 1.177–7.561; P = 0.021).

CONCLUSIONS—The development of cardiovascular autonomic dysfunction was independently associated with microvascular complications and glycemic control status during this 7.5-year follow-up in patients with type 2 diabetes.


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