Tarakeshwari, M (2007) Cardiac Dysautonomia in Type 2 Diabetes Mellitus. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: The term diabetes mellitus describes several diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia. It is associated with a relative or a absolute impairment in insulin secretion, along with varying degrees of peripheral resistance to the action of insulin. The American Diabetes Association recommends the fasting plasma glucose because it is easier, faster and less expensive to perform. With the FPG test, a fasting glucose level between 100 and 126 mg/dl signals prediabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. One can also use oral glucose tolerance test (OGTT) to diagnose diabetes, but OGTT is cumbersome and hence is not preferred at most centers. It is performed by measuring a blood glucose level in the fasting state and again two hours after taking 75g of glucose or any glucose rich beverage. If the two hour blood glucose value is at 200 mg/dl or higher, the person tested has diabetes. The estimated prevalence of diabetes worldwide is about 3,822,720 for the year 2003. This amounts to 5% of the world population. The South East Asian Region accounts for 705,292 cases. The estimated population affected in India is 6,03,677. With such high prevalence it is essential to institute measures to prevent diabetes hence the ADA has introduced the term prediabetes for IFG and IGT to create awareness. AIM OF THE STUDY: 1. To study the prevalence of cardiac dysautonomia in type 2 diabetic patients by clinical and electrocardiographic methods. 2. To study the prevalence of various ECG abnormalities in type 2 diabetic patients as compared to controls. 3. To study the correlation between symptoms and signs of cardiac dysautonomia in type 2 diabetic patients. MATERIALS AND METHODS : MATERIALS: 1. Study Population Fifty diabetic patients attending Diabetology Outpatient Department, Govt. Royapettah Hospital, Chennai. These subjects were selected after scrutinizing them for exclusion criteria. Control Populations: Fifty patients attending General Medical Outpatient Department at Govt. Royapettah Hospital. These subjects were age and sex matched controls. Place of Study: Out patient department, Diabetology department, Govt. Royapettah Hospital and Kilpauk Medical College, Chennai. Period of Study: February 2005 – July 2005. METHODS: All study group patients and controls were subjected for thorough physical examination. Blood samples were drawn and subjected to estimation of plasma glucose and renal function tests. Exclusion Criteria: · Age >65 years. · Documented coronary artery disease. · Documented valvular or congenital heart disease. · Hypertension. · Chronic obstructive pulmonary disease. · History of drug intake – Beta Blocker, digoxin, calcium channel blockers. · Hypothyroidism. · Chronic kidney disease and uremia. · Treatment for parkinsonism. CONCLUSION: The following ECG parameters were abnormal in Diabetic study group as compared to control population. · The resting heart rate (86.16±7.6) was significantly (P<0.05) higher than that of non diabetic controls (76.64±9.18). · The RR interval was narrow in diabetic (701.6 ± 72.9 msec) as compared to control subjects (794 ± 92.25 msec) which was statistically significant. · The PR interval in diabetics (163 ± 32.84 msec) was prolonged as compared to control (136 ± 19.794) and was statistically significant (P= 0.0003). · There was a leftward deviation of QRS axis among diabetics (31.6°) as compared to controls (54°). · QTc interval was prolonged (400.62 ± 32.18 msec) in diabetic study population which was significant (P=0.0000). · There was an increased prevalence of ischemia and infarction in diabetics as was evidenced by ECG changes (38%). · Asymptomatic ischemic heart disease was more common (36.84%) among diabetics as compared to control subjects. · Varying degrees of conduction blocks were prevalent in diabetics (6%). Cardiac dysautonomia was demonstrated in the study population using the following parameters. · Abnormal E:I ratio (£ 1.1) (30%). · Prolonged QTc interval (> 460 msec) (6%) · Postural fall in systolic blood pressure (> 30 mmHg) (10%). This study shows the high prevalence of cardiac dysautonomia in type 2 diabetics. Most of these patients remain asymptomatic. Some of the patients with CAN had diabetes for only as few as 5 years proving the DCCT result that the disease process begins early and it may remain asymptomatic until later stages. It can be recommended that a baseline determination of cardiac autonomic function be performed upon diagnosis in type 2 diabetes followed by a yearly repeat test.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Cardiac Dysautonomia ; Type 2 Diabetes Mellitus. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Mar 2018 04:16 |
| Last Modified: | 10 Mar 2018 04:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6114 |
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