Detection of Early Sympathetic Cardiovascular Neuropathy by Squatting Test in NIDDM

Raffaele Marfella; Teresa Salvatore; Dario Glugliano; Giosue Di Maro; Riccardo Giunta; Roberto Torella; Jacques Juchmes; Andre Scheen; Pierre J Lefebvre

doi:10.2337/diacare.17.2.149

Short Reports

Detection of Early Sympathetic Cardiovascular Neuropathy by Squatting Test in NIDDM

Raffaele Marfella, MD,
Teresa Salvatore, MD,
Dario Glugliano, MD,
Giosue Di Maro, MD,
Riccardo Giunta, MD,
Roberto Torella, MD,
Jacques Juchmes, MD,
Andre Scheen, MD and
Pierre J Lefebvre, MD

Department of Gerontology, Geriatrics, Metabolic Diseases, Faculty of Medicine, Second University of Naples Naples, Italy Faculty of Medicine, University of Liége Liége, Belgium
Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, University of Liége Liége, Belgium
Institut Leon Fredericq, Department of Physiology, Faculty of Medicine, University of Liége Liége, Belgium

Address correspondence and reprint requests to Dario Giugliano, MD, Via Emilia 1, 80021 Afragola (NA), Italy.

Diabetes Care 1994 Feb; 17(2): 149-151. https://doi.org/10.2337/diacare.17.2.149

Abstract

OBJECTIVE To determine the role of the squatting test in the detection of early sympathetic neuropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS Three groups of nonsmoking, nonobese subjects were studied: 10 healthy subjects, 10 NIDDM patients without autonomic neuropathy (AN), and 10 NIDDM patients with AN defined by the presence of a pathological deep-breathing value. All subjects were given three postural tests: lying-to-standing, sitting-to-standing, and squatting test. Heart rate (HR) and finger arterial pressure were recorded with a noninvasive technique.

RESULTS Blood pressure (BP) fall (expressed as decremental area) was not significantly different among the groups at standing up after sitting or lying. By contrast, a significantly greater BP drop occurred in NIDDM patients with AN (1,123 ± 245 mm²) compared with NIDDM patients without AN (460 ± 232 mm²) or normal subjects (429 ± 138 mm², P < 0.001). The HR increase after all the orthostatic maneuvers was smaller in diabetic patients with AN (P < 0.01) compared with that recorded in other groups. Significant correlations were observed between BP fall after squatting and either the expiration:inspiration ratio at deep breathing (r = -0.77, P < 0.001) or the duration of diabetes (r = 0.76, P < 0.001).

CONCLUSIONS The intrinsic orthostatic load of the squatting test, which is greater than conventional postural maneuvers, makes the squatting test an easy and useful test to detect early orthostatic dysregulation in NIDDM.