Associations between postural hypotension and neuropathy in type 2 diabetes

Due to its association with mortality, it has been recommended that autonomic function be assessed at diagnosis of type 2 diabetes and then annually. A simple surrogate of autonomic dysfunction is orthostatic hypotension (OH).

Australian researchers studied 417 unselected type 2 patients from the Fremantle Diabetes Study Phase II who underwent assessment of autonomic neuropathy. OH was defined as a fall of ≥20 mm Hg systolic or ≥10 mm Hg diastolic blood pressure on standing. Two of the methods that evaluated the autonomic neuropathy were the 30:15 Stand test (R-R interval at beat 30/R-R interval at beat 15 on standing) and EZscan which generates autonomic risk scores based on sudomotor function.

The mean age of the patients was 65.8 years, 54.2% were male, their median diabetes duration was 10.0 years and 26.3% had OH. In logistic regression, OH was independently associated with supine systolic blood pressure (OR 1.28, 95%CI, P<0.001 for a 10 mm Hg increase), diabetes duration (OR 1,21, P=0,012 for a 5-year increase), 30:15 Stand test (OR 0.35, P=0.007), and the EZscan autonomic risk score (OR 0.97, P=0.011).

Authors conclude that OH is a manifestation of complex dysfunction of parasympathetic and sympathetic systems, and EZscan, a quick and simple procedure, can contribute to prediction of cardiovascular autonomic dysfunction independently of conventional heart rate-based tests.

Source: T.M.E. Davis, Associations between postural hypotension and neuropathy in type 2 diabetes: the Fremantle Diabetes study phase II, EASD Virtual Meeting 2013