Abstract Details

Patients with a DAN are known to be at higher risk for silent myocardial ischemia and sudden cardiac death. We analyzed data from a customized electronic medical record based, structured clinical documentation (SCDS) toolkit, which captures standardized polyneuropathy patient data in a longitudinal fashion, to understand risk factors for death in DAN patients.

To identify mortality risk factors in patients diagnosed with diabetic autonomic neuropathy (DAN). 

Kaplan-Meier survival analyses were conducted in 54 DAN patients (17 deceased) diagnosed by measuring postganglionic sudomotor function, heart rate variability to deep breathing (HRDB), Valsalva ratios (VR), baroreflex vagal sensitivity (BRV), pressure recovery time (PRT) after a Valsalva maneuver and abnormalities found during head up tilt table (HUT) testing. Log-rank tests were used to evaluate whether increased mortality following the testing date was associated with the presence of abnormal (≤5^th percentile) scores on any of these tests, type 1 vs. type 2 diabetes mellitus (DM), stroke, cardiac disease, or somatic diabetic polyneuropathy. 

Patients with coexistent documented cardiac disease, specifically ventricular tachycardia (VT) had higher mortality (p=0.01). Patients with a documented history of stroke (p=0.06) or cardiomyopathy (p=0.07) had a higher mortality although this did not reach statistical significance.  Survival was similar in type 1 vs. type 2 DM (p=0.76).

Patients with length dependent sudomotor loss had higher mortality (p=0.038), unlike patients with patchy involvement (p=0.69). For indices of cardiovagal function, an abnormal VR (p=0.046) but not an abnormal HRDB (p=0.75) predicted higher mortality. An abnormal BRV (p=0.84) and PRT (p=0.50) did not predict higher mortality. During HUT, the presence of orthostatic hypotension (p=0.037) (compensated or not) but not inappropriate tachycardia (p=0.67) predicted higher mortality.

In our cohort, documented VT, length dependent sudomotor loss, low VR and orthostatic hypotension during HUT are associated with higher mortality.