Identification and performance of multiple clinical and laboratorial risk factors for diagnosis of cardiac autonomic neuropathy in type 1 diabetes patients

  • Cinthia Minatel Riguetto
  • Caroline Rigoleto Takano
  • Sharon Nina Admoni
  • Maria Candida Ribeiro Parisi
  • Maria Lucia Correa Giannella
  • Elizabeth João Pavin
  • Arnaldo Moura NetoEmail author
Research article



The incidence of cardiac autonomic neuropathy (CAN) in patients with type 1 diabetes (T1D) is frequently underestimated. Individuals with T1D and CAN have an increased mortality risk, mainly from cardiovascular causes. The objectives of the present study were to assess the clinical and laboratory characteristics associated with CAN in patients with T1D and verify the ability of multiple clinical factors to help identify patients with this condition.


102 patients with T1D were evaluated for CAN using standardized cardiovascular reflex testing. Clinical characteristics were used to compute a numerical score for CAN diagnosis and a ROC curve elaborated for assessment of the best cutoff to predict CAN. This score was then applied to the second sample of 120 patients. The sensitivity, specificity, and positive and negative predictive values were calculated.


Prevalence of CAN was around 35% in the first sample of patients and just below 20% in the second sample. Hypertension, total cholesterol, triglycerides, postprandial sweating, diastolic blood pressure, abnormal right and left 10 g monofilament, retinopathy, and nephropathy were considered independent predictors of CAN. The CAN-score cut-off was 16.88. This yielded a sensitivity of 50%, specificity 73.8%, positive predictive value 22.9%, and negative predictive value 90.5%.


The use of a subset of clinical and laboratory characteristics can be more accessible than the cardiac reflex tests and more accurate than a single isolated characteristic.


Cardiac autonomic neuropathy Type 1 diabetes Cardiovascular reflex test Heart rate variability 



We acknowledge all the patients who voluntarily participated in our study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cinthia Minatel Riguetto
    • 1
  • Caroline Rigoleto Takano
    • 1
  • Sharon Nina Admoni
    • 2
  • Maria Candida Ribeiro Parisi
    • 1
  • Maria Lucia Correa Giannella
    • 2
  • Elizabeth João Pavin
    • 1
  • Arnaldo Moura Neto
    • 1
    Email author
  1. 1.Endocrinology Division, Internal Medicine Department, Faculty of Medical SciencesUniversity of CampinasSão PauloBrazil
  2. 2.Serviço de Endocrinologia e Metabologia do Hospital da Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

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