Influence of Cardiac Autonomic Neuropathy in Relation with HBA1c Values: A Prospective Cross-Sectional Study

Amit  Chakraborty

doi:10.51168/sjhrafrica.v5i6.1264

Authors

Amit Chakraborty Consultant Endocrinologist & Diabetologist, MBBS, DNB, PhD, MSc (Diabetology), MSc (Endocrinology), DM (Endocrinology), Postdoctoral Fellow in Diabetology, RG KAR Medical College, Kolkata, India

DOI:

https://doi.org/10.51168/sjhrafrica.v5i6.1264

Keywords:

Cardiac autonomic neuropathy, Hemoglobin A1c, Type 2 diabetes mellitus, Glycemic variability, Cardiovascular risk factors

Abstract

Background: One common adverse effect of diabetic mellitus (DM) is cardiac autonomic neuropathy (CAN), affecting cardiovascular function and often linked to poor glycemic control measured by hemoglobin A1c (HbA1c) values. The study seeks to investigate the association between CAN and HbA1c variability, predict CAN development and progression based on HbA1c levels, and assess the impact of glycemic control on autonomic dysfunction in DM patients.

Methods: A prospective study was carried out involving 100 Type 2 DM patients. Inclusion criteria included age ≥18 years, Type 2 DM duration ≥10 years, and ≥4 HbA1c measurements. CAN was evaluated using the Cardiovascular Autonomic Score Scale (CASS). Descriptive statistics, logistic regression, correlation analysis, and multiple linear regression analysis were used for data analysis.

Results: The mean age of participants was 58 years, with 60% males. Key findings include significant differences in CA parameters between patients with and without CAN (p < 0.001). Factors like mean HbA1c (OR 1.32, p < 0.001), adjusted HbA1c standard deviation (OR 2.45, p < 0.001), BMI (OR 1.18, p = 0.017), duration of DM (OR 1.27, p = 0.002), hypertension (OR 3.21, p = 0.002), coronary artery disease (OR 2.55, p = 0.012), and diabetic retinopathy (OR 1.89, p = 0.039) were substantially associated with composite autonomic scoring.

Conclusion: The study highlights the critical role that cardiovascular risk factors and glycemic management play in the onset and progression of CAN in patients with Type 2 DM. Older age, longer DM duration, higher BMI, hypertension, and coronary artery disease were significantly associated with increased composite autonomic scoring, indicating a greater severity of autonomic neuropathy.

Recommendations: Intensive glycemic management and targeted interventions addressing cardiovascular risk factors are recommended to mitigate CAN risks and improve outcomes in Type 2 DM patients.