Detection of cardiovascular autonomic neuropathy using exercise testing in patients with type 2 diabetes mellitus

Smriti Banthia, Daniel W. Bergner, Alexandru B. Chicos, Jason Ng, Daniel J. Pelchovitz, Haris Subacius, Alan H. Kadish, Jeffrey Goldberger

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aims: This study investigated autonomic nervous system function in subjects with diabetes during exercise and recovery. Methods: Eighteen type 2 diabetics (age 55 ± 2 years) and twenty healthy controls (age 51 ± 1 years) underwent two 16-min bicycle submaximal ECG stress tests followed by 45 min of recovery. During session #2, atropine (0.04 mg/kg) was administered at peak exercise, and the final two minutes of exercise and entire recovery occurred under parasympathetic blockade. Plasma catecholamines were measured throughout. Parasympathetic effect was defined as the difference between a measured parameter at baseline and after parasympathetic blockade. Results: The parasympathetic effect on the RR interval was blunted (P =.004) in diabetic subjects during recovery. Parasympathetic effect on QT-RR slope during early recovery was diminished in the diabetes group (diabetes 0.13 ± 0.02, control 0.21 ± 0.02, P =.03). Subjects with diabetes had a lower heart rate recovery at 1 min (diabetes 18.5 ± 1.9 bpm, control 27.6 ± 1.5 bpm, P <.001). Conclusions: In subjects with well-controlled type 2 diabetes, even with minimal evidence of CAN using current methodology, altered cardiac autonomic balance is present and can be detected through an exercise-based assessment for CAN. The early post-exercise recovery period in diabetes was characterized by enhanced sympathoexcitation, diminished parasympathetic reactivation and delay in heart rate recovery.

Original languageEnglish (US)
Pages (from-to)64-69
Number of pages6
JournalJournal of Diabetes and its Complications
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Type 2 Diabetes Mellitus
Exercise
Heart Rate
Autonomic Nervous System
Atropine
Exercise Test
Catecholamines
Electrocardiography

Keywords

  • Cardiac autonomic neuropathy
  • Diabetes mellitus
  • Exercise

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Detection of cardiovascular autonomic neuropathy using exercise testing in patients with type 2 diabetes mellitus. / Banthia, Smriti; Bergner, Daniel W.; Chicos, Alexandru B.; Ng, Jason; Pelchovitz, Daniel J.; Subacius, Haris; Kadish, Alan H.; Goldberger, Jeffrey.

In: Journal of Diabetes and its Complications, Vol. 27, No. 1, 01.01.2013, p. 64-69.

Research output: Contribution to journalArticle

Banthia, Smriti ; Bergner, Daniel W. ; Chicos, Alexandru B. ; Ng, Jason ; Pelchovitz, Daniel J. ; Subacius, Haris ; Kadish, Alan H. ; Goldberger, Jeffrey. / Detection of cardiovascular autonomic neuropathy using exercise testing in patients with type 2 diabetes mellitus. In: Journal of Diabetes and its Complications. 2013 ; Vol. 27, No. 1. pp. 64-69.
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N2 - Aims: This study investigated autonomic nervous system function in subjects with diabetes during exercise and recovery. Methods: Eighteen type 2 diabetics (age 55 ± 2 years) and twenty healthy controls (age 51 ± 1 years) underwent two 16-min bicycle submaximal ECG stress tests followed by 45 min of recovery. During session #2, atropine (0.04 mg/kg) was administered at peak exercise, and the final two minutes of exercise and entire recovery occurred under parasympathetic blockade. Plasma catecholamines were measured throughout. Parasympathetic effect was defined as the difference between a measured parameter at baseline and after parasympathetic blockade. Results: The parasympathetic effect on the RR interval was blunted (P =.004) in diabetic subjects during recovery. Parasympathetic effect on QT-RR slope during early recovery was diminished in the diabetes group (diabetes 0.13 ± 0.02, control 0.21 ± 0.02, P =.03). Subjects with diabetes had a lower heart rate recovery at 1 min (diabetes 18.5 ± 1.9 bpm, control 27.6 ± 1.5 bpm, P <.001). Conclusions: In subjects with well-controlled type 2 diabetes, even with minimal evidence of CAN using current methodology, altered cardiac autonomic balance is present and can be detected through an exercise-based assessment for CAN. The early post-exercise recovery period in diabetes was characterized by enhanced sympathoexcitation, diminished parasympathetic reactivation and delay in heart rate recovery.

AB - Aims: This study investigated autonomic nervous system function in subjects with diabetes during exercise and recovery. Methods: Eighteen type 2 diabetics (age 55 ± 2 years) and twenty healthy controls (age 51 ± 1 years) underwent two 16-min bicycle submaximal ECG stress tests followed by 45 min of recovery. During session #2, atropine (0.04 mg/kg) was administered at peak exercise, and the final two minutes of exercise and entire recovery occurred under parasympathetic blockade. Plasma catecholamines were measured throughout. Parasympathetic effect was defined as the difference between a measured parameter at baseline and after parasympathetic blockade. Results: The parasympathetic effect on the RR interval was blunted (P =.004) in diabetic subjects during recovery. Parasympathetic effect on QT-RR slope during early recovery was diminished in the diabetes group (diabetes 0.13 ± 0.02, control 0.21 ± 0.02, P =.03). Subjects with diabetes had a lower heart rate recovery at 1 min (diabetes 18.5 ± 1.9 bpm, control 27.6 ± 1.5 bpm, P <.001). Conclusions: In subjects with well-controlled type 2 diabetes, even with minimal evidence of CAN using current methodology, altered cardiac autonomic balance is present and can be detected through an exercise-based assessment for CAN. The early post-exercise recovery period in diabetes was characterized by enhanced sympathoexcitation, diminished parasympathetic reactivation and delay in heart rate recovery.

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