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Clinical Autonomic Research

, Volume 21, Issue 1, pp 29–35 | Cite as

Inspiratory muscle weakness is associated with autonomic cardiovascular dysfunction in patients with type 2 diabetes mellitus

  • Diogo Machado Kaminski
  • Beatriz D’Agord Schaan
  • Antônio Marcos Vargas da Silva
  • Pedro Paulo Soares
  • Rodrigo Della Méa Plentz
  • Pedro Dall’AgoEmail author
Research Article

Abstract

Introduction

Diabetic autonomic neuropathy is a complication of diabetes mellitus (DM) that can cause cardiovascular and respiratory abnormalities. The association between respiratory muscle weakness and autonomic cardiovascular neuropathy has not yet been studied. The aims of the present study were to assess respiratory muscle strength, pulmonary function, and heart rate (HR) variability in diabetic patients with and without diabetic autonomic neuropathy.

Materials and methods

Twenty-four patients with type 2 DM were divided into two groups: those without diabetic autonomic neuropathy (C group, n = 12); and those with diabetic autonomic neuropathy (DAN group, n = 12). We evaluated pulmonary function, maximum static inspiratory pressure (PImax), maximum static expiratory pressure (PEmax), and HR variability.

Results

The results of the pulmonary function tests were similar in both the groups. PImax was lower in the DAN group (80 ± 24 vs. 102 ± 24 cmH2O, p = 0.03), but PEmax was similar in both the groups. RR intervals (878 ± 122 vs. 743 ± 88 ms; p < 0.01), standard deviation of RR intervals (28 ± 11 vs. 14 ± 4 ms; p < 0.01) and squared root of the sum of successive differences of squared RR intervals (15 ± 6 vs. 8 ± 5 ms; p < 0.01) were higher in the C group. In the DAN group, resting HR was higher (82 ± 10 vs. 69 ± 9 bpm; p = 0.01) than in the C group. There was a positive correlation between PImax and RR intervals (r = 0.452, p = 0.02) and a negative correlation between PImax and resting HR (r = −0.482, p = 0.01), and PImax and DM duration (r = −0.463, p = 0.02).

Conclusion

Patients with type 2 DM and autonomic neuropathy showed reduced respiratory muscle strength and less HR variability. Respiratory muscle weakness may be associated with autonomic dysfunction in these patients.

Keywords

Diabetes mellitus type 2 Diabetic neuropathies Respiratory muscle weakness Heart rate variability 

References

  1. 1.
    (1995) Standardization of Spirometry, (1994) Update. American Thoracic Society. Am J Respir Crit Care Med 152:1107–1136Google Scholar
  2. 2.
    (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 17:354–381Google Scholar
  3. 3.
    (1997) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20:1183–1197Google Scholar
  4. 4.
    Andersen H, Nielsen S, Mogensen CE, Jakobsen J (2004) Muscle strength in type 2 diabetes. Diabetes 53:1543–1548CrossRefPubMedGoogle Scholar
  5. 5.
    Ardigo D, Valtuena S, Zavaroni I, Baroni MC, Delsignore R (2004) Pulmonary complications in diabetes mellitus: the role of glycemic control. Curr Drug Targets Inflamm Allergy 3:455–458CrossRefPubMedGoogle Scholar
  6. 6.
    Bertherat J, Lubetzki J, Lockhart A, Regnard J (1991) Decreased bronchial response to methacholine in IDDM patients with autonomic neuropathy. Diabetes 40:1100–1106CrossRefPubMedGoogle Scholar
  7. 7.
    Chiappa GR, Roseguini BT, Vieira PJ, Alves CN, Tavares A, Winkelmann ER, Ferlin EL, Stein R, Ribeiro JP (2008) Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol 51:1663–1671CrossRefPubMedGoogle Scholar
  8. 8.
    Dall’Ago P, Chiappa GR, Guths H, Stein R, Ribeiro JP (2006) Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol 47:757–763CrossRefPubMedGoogle Scholar
  9. 9.
    Douglas NJ, Campbell IW, Ewing DJ, Clarke BF, Flenley DC (1981) Reduced airway vagal tone in diabetic patients with autonomic neuropathy. Clin Sci (Lond) 61:581–584Google Scholar
  10. 10.
    Ewing DJ, Campbell IW, Clarke BF (1980) The natural history of diabetic autonomic neuropathy. Q J Med 49:95–108PubMedGoogle Scholar
  11. 11.
    Ewing DJ, Campbell IW, Clarke BF (1981) Heart rate changes in diabetes mellitus. Lancet 1:183–186CrossRefPubMedGoogle Scholar
  12. 12.
    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 285:916–918CrossRefGoogle Scholar
  13. 13.
    Frankenstein L, Meyer FJ, Sigg C, Nelles M, Schellberg D, Remppis A, Katus HA, Zugck C (2008) Is serial determination of inspiratory muscle strength a useful prognostic marker in chronic heart failure? Eur J Cardiovasc Prev Rehabil 15:156–161CrossRefPubMedGoogle Scholar
  14. 14.
    Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG (1996) Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 153:961–966PubMedGoogle Scholar
  15. 15.
    Heaton RW, Guy RJ, Gray BJ, Watkins PJ, Costello JF (1984) Diminished bronchial reactivity to cold air in diabetic patients with autonomic neuropathy. Br Med J (Clin Res Ed) 289:149–151CrossRefGoogle Scholar
  16. 16.
    Heimer D, Brami J, Lieberman D, Bark H (1990) Respiratory muscle performance in patients with type 1 diabetes. Diabet Med 7:434–437CrossRefPubMedGoogle Scholar
  17. 17.
    Kabitz HJ, Sonntag F, Walker D, Schwoerer A, Walterspacher S, Kaufmann S, Beuschlein F, Seufert J, Windisch W (2008) Diabetic polyneuropathy is associated with respiratory muscle impairment in type 2 diabetes. Diabetologia 51:191–197CrossRefPubMedGoogle Scholar
  18. 18.
    Knudson RJ, Slatin RC, Lebowitz MD, Burrows B (1976) The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis 113:587–600PubMedGoogle Scholar
  19. 19.
    Kudat H, Akkaya V, Sozen AB, Salman S, Demirel S, Ozcan M, Atilgan D, Yilmaz MT, Guven O (2006) Heart rate variability in diabetes patients. J Int Med Res 34:291–296PubMedGoogle Scholar
  20. 20.
    Maser RE, Lenhard MJ (2005) Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab 90:5896–5903CrossRefPubMedGoogle Scholar
  21. 21.
    Maser RE, Mitchell BD, Vinik AI, Freeman R (2003) The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care 26:1895–1901CrossRefPubMedGoogle Scholar
  22. 22.
    Meo SA, Al-Drees AM, Arif M, Al-Rubean K (2006) Lung function in type 2 Saudi diabetic patients. Saudi Med J 27:338–343PubMedGoogle Scholar
  23. 23.
    Neder JA, Andreoni S, Lerario MC, Nery LE (1999) Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res 32:719–727PubMedGoogle Scholar
  24. 24.
    Neumann C, Schmid H (1997) Standardization of a computerized method for calculating autonomic function test responses in healthy subjects and patients with diabetes mellitus. Braz J Med Biol Res 30:197–205CrossRefPubMedGoogle Scholar
  25. 25.
    Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Newman AB (2006) Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 55:1813–1818CrossRefPubMedGoogle Scholar
  26. 26.
    Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care 46:798–825PubMedGoogle Scholar
  27. 27.
    Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS (2006) Heart rate variability: a review. Med Biol Eng Comput 44:1031–1051CrossRefPubMedGoogle Scholar
  28. 28.
    Rodrigues Filho OA, Fazan VP (2006) Streptozotocin induced diabetes as a model of phrenic nerve neuropathy in rats. J Neurosci Methods 151:131–138CrossRefPubMedGoogle Scholar
  29. 29.
    Santos e Fonseca CM, Manco JC, Gallo Junior L, Barreira AA, Foss MC (1992) Cholinergic bronchomotor tone and airway caliber in insulin-dependent diabetes mellitus. Chest 101:1038–1043CrossRefPubMedGoogle Scholar
  30. 30.
    Soares PP, Moreno AM, Cravo SL, Nobrega AC (2005) Coronary artery bypass surgery and longitudinal evaluation of the autonomic cardiovascular function. Crit Care 9:R124–R131CrossRefPubMedGoogle Scholar
  31. 31.
    St Croix CM, Morgan BJ, Wetter TJ, Dempsey JA (2000) Fatiguing inspiratory muscle work causes reflex sympathetic activation in humans. J Physiol 529(Pt 2):493–504CrossRefPubMedGoogle Scholar
  32. 32.
    Sun Z, Liu L, Liu N, Liu Y (2008) Muscular response and adaptation to diabetes mellitus. Front Biosci 13:4765–4794CrossRefPubMedGoogle Scholar
  33. 33.
    Tantucci C, Bottini P, Dottorini ML, Puxeddu E, Casucci G, Scionti L, Sorbini CA (1996) Ventilatory response to exercise in diabetic subjects with autonomic neuropathy. J Appl Physiol 81:1978–1986PubMedGoogle Scholar
  34. 34.
    Tantucci C, Scionti L, Bottini P, Dottorini ML, Puxeddu E, Casucci G, Sorbini CA (1997) Influence of autonomic neuropathy of different severities on the hypercapnic drive to breathing in diabetic patients. Chest 112:145–153CrossRefPubMedGoogle Scholar
  35. 35.
    Vinik AI, Maser RE, Mitchell BD, Freeman R (2003) Diabetic autonomic neuropathy. Diabetes Care 26:1553–1579CrossRefPubMedGoogle Scholar
  36. 36.
    Vinik AI, Ziegler D (2007) Diabetic cardiovascular autonomic neuropathy. Circulation 115:387–397CrossRefPubMedGoogle Scholar
  37. 37.
    Wanke T, Formanek D, Auinger M, Popp W, Zwick H, Irsigler K (1991) Inspiratory muscle performance and pulmonary function changes in insulin-dependent diabetes mellitus. Am Rev Respir Dis 143:97–100PubMedGoogle Scholar
  38. 38.
    Ziegler D, Gries FA, Muhlen H, Rathmann W, Spuler M, Lessmann F (1993) Prevalence and clinical correlates of cardiovascular autonomic and peripheral diabetic neuropathy in patients attending diabetes centers. The Diacan Multicenter Study Group. Diabete Metab 19:143–151PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Diogo Machado Kaminski
    • 1
  • Beatriz D’Agord Schaan
    • 1
    • 2
  • Antônio Marcos Vargas da Silva
    • 3
  • Pedro Paulo Soares
    • 4
  • Rodrigo Della Méa Plentz
    • 1
    • 5
  • Pedro Dall’Ago
    • 5
    Email author
  1. 1.Graduate Program in Health Sciences/Cardiology, Heart InstituteFundação Universitária de Cardiologia do Rio Grande do Sul (IC/FUC)Porto AlegreBrazil
  2. 2.Division of Endocrinology, Department of Internal Medicine, Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  3. 3.Department of Physical Therapy and RehabilitationUniversidade Federal de Santa MariaSanta MariaBrazil
  4. 4.Universidade Federal Fluminense (UFF)NiteróiBrazil
  5. 5.Department of Physical TherapyUniversidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)Porto AlegreBrazil

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