Cardiovascular Variability Analysis and Baroreflex Estimation in Patients with Type 2 Diabetes in Absence of Any Manifest Neuropathy

• Published in: PloS one 2016-03, Vol.11 (3), p.e0148903-e0148903
• Main Authors: de Moura-Tonello, Sílvia Cristina Garcia, Porta, Alberto, Marchi, Andrea, de Almeida Fagundes, Alessandra, Francisco, Cristina de Oliveira, Rehder-Santos, Patrícia, Milan-Mattos, Juliana Cristina, Simões, Rodrigo Polaquini, Gois, Mariana de Oliveira, Catai, Aparecida Maria
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; Autonomic nervous system; Autonomic neuropathies; Baroreceptors; Baroreflex; Biology and Life Sciences; Blood pressure; Blood vessels; Cardiovascular system; Cardiovascular System - innervation; Cardiovascular System - physiopathology; Care and treatment; Complications and side effects; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Neuropathies - complications; Diabetic Neuropathies - physiopathology; Diabetic neuropathy; Glucose; Heart diseases; Heart Rate; Hemoglobin; Humans; Laboratories; Low frequencies; Male; Males; Medicine and Health Sciences; Middle Aged; Neuropathy; Patients; Physical therapy; Population; Reflexes; Respiration; Rest; Risk factors; SAP protein; Supine position; Type 2 diabetes; Vagus nerve; Variability
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0148903

Indexes derived from spontaneous heart period (HP) and systolic arterial pressure (SAP) fluctuations can detect autonomic dysfunction in individuals with type 2 diabetes mellitus (DM) associated to cardiovascular autonomic neuropathy (CAN) or other neuropathies. It is unknown whether HP and SAP variability indexes are sensitive enough to detect the autonomic dysfunction in DM patients without CAN and other neuropathies. We evaluated 68 males aged between 40 and 65 years. The group was composed by DM type 2 DM with no manifest neuropathy (n = 34) and healthy (H) subjects (n = 34). The protocol consisted of 15 minutes of recording of HP and SAP variabilities at rest in supine position (REST) and after active standing (STAND). The HP power in the high frequency band (HF, from 0.15 to 0.5 Hz), the SAP power in the low frequency band (LF, from 0.04 to 0.15 Hz) and BRS estimated via spectral approach and sequence method were computed. The HF power of HP was lower in DM patients than in H subjects, while the two groups exhibited comparable HF power of HP during STAND. The LF power of SAP was similar in DM and H groups at REST and increased during STAND in both groups. BRSs estimated in the HF band and via baroreflex sequence method were lower in DM than in H and they decreased further during STAND in both populations. Results suggest that vagal control of heart rate and cardiac baroreflex control was impaired in type 2 DM, while sympathetic control directed to vessels, sympathetic and baroreflex response to STAND were preserved. Cardiovascular variability indexes are sensitive enough to typify the early, peculiar signs of autonomic dysfunction in type-2 DM patients well before CAN becomes manifest.