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Effect of glycemic control and disease duration on cardiac autonomic function and oxidative stress in type 2 diabetes mellitus

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Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Purpose

Cardiac autonomic neuropathy (CAN) is a commonly overlooked complication of type 2 diabetes mellitus (T2DM), with a complex pathogenesis involving hyperglycemia-induced oxidative stress which results in neuronal ischemia and cellular death. The level of hyperglycemia as well as disease duration might be significant determinants of the prognosis of T2DM, but limited studies have explored their relationship with these diabetic complications. Therefore, the purpose of this study was to examine the effect of glycemic control and disease duration on cardiac autonomic function and oxidative stress in patients with T2DM.

Methods

60 T2DM patients along with 63 healthy controls were recruited for the study. Diabetic patients were further classified based on glycemic control (HbA1c levels <8% vs. ≥8%) and disease duration (<5 vs. 5–10 vs. >10 years). All participants were assessed for cardiac autonomic function (HRR: heart rate recovery; HRV: heart rate variability), levels of antioxidant enzymes (CAT: catalase; SOD: superoxide dismutase), serum nitric oxide (NO) and other cardiometabolic risk factors (resting blood pressure, glycemic and lipid profile).

Results

T2DM patients showed a significant reduction in HRR, HRV, CAT, SOD and an increase in LFnu, LF: HF ratio and NO. These impairments were significantly greater for the group with poor glycemic control (p < 0.05). However, no difference for these parameters was observed with respect to different disease durations.

Conclusion

Cardiac autonomic regulation and endogenous antioxidant defense were compromised and levels of nitric oxide found to be raised in patients with Type 2 diabetes. These findings were more pronounced in subjects with poor glycemic control.

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Abbreviations

T2DM:

Type 2 Diabetes Mellitus

CAN:

Cardiac Autonomic Neuropathy

NO:

Nitric Oxide

ROS:

Reactive Oxygen Species

HRR:

Heart Rate Recovery

HRV:

Heart Rate Variability

CAT:

Catalase

SOD:

Superoxide Dismutase

HDL-c:

High-density lipoprotein cholesterol

LDL-c:

Low-density lipoprotein cholesterol

SBP:

Systolic Blood Pressure

DBP:

Diastolic Blood Pressure

AvgNN:

Mean of N-N intervals

SDNN:

Standard deviation of N-N intervals

RMSSD:

Square root of the mean squared differences between adjacent RR intervals

pNN50:

Percentage of interval differences of adjacent RR intervals greater than 50 milliseconds derived from differences between consecutive RR intervals

TP:

Total power

LF nu:

Low frequency power normalize units

HF nu:

High frequency power normalize units LF/HF ratio: Ratio of low and high frequency power

eNOS:

endothelial Nitric Oxide Synthase

nNOS:

neuronal Nitric Oxide Synthase

iNOS:

inducible Nitric Oxide Synthase.

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Acknowledgements

Authors would like to thank all the participants involved in the study and acknowledge the contribution of the staff at the Centre for Physiotherapy and Rehabilitation Sciences, and DDU Kaushal Kendra, for facilitating data collection for this study.

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Authors and Affiliations

  1. Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, 110025, India

    Shalini Verma, Irshad Ahmad, Deepika Singla, Kamran Ali & Mohammed E. Hussain

  2. Deen Dayal Upadhyay Kaushal Kendra (DDUKK), Jamia Millia Islamia (Central University), New Delhi, 110025, India

    Rizwan Alam

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  1. Shalini Verma
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  2. Rizwan Alam
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Contributions

SV and MEH contributed to the creation and design of the study. The co-authors provided expertise as follows: SV and IA were involved in enrolling the patients and assessments. SV and MEH drafted the global study methodology and statistical methods. SV and RA performed the biochemical analyses. DS and KA were involved in manuscript revision and critical review. All authors helped to write the article and have proofread and approved the final manuscript.

Corresponding author

Correspondence to Shalini Verma.

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Competing interests

The authors declare that they have no competing interests.

Ethical approval and consent to participate

The study was approved by the Institutional Ethical Committee, Jamia Millia Islamia. (Date: 23 February 2016; IEC reference No: 17/9/43/JMI/IEC/2015). All procedures followed were in accordance with the institutional ethical standards for human experimentation and with the Helsinki Declaration. All participants were given an information sheet explaining the study purpose, methodology as well as their rights as research subjects and written consent was obtained.

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Verma, S., Alam, R., Ahmad, I. et al. Effect of glycemic control and disease duration on cardiac autonomic function and oxidative stress in type 2 diabetes mellitus. J Diabetes Metab Disord 17, 149–158 (2018). https://doi.org/10.1007/s40200-018-0354-6

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  • DOI: https://doi.org/10.1007/s40200-018-0354-6

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