Sandra E Olsen1, Marit R Bjørgaas2, Bjørn O Åsvold3, Trond Sand4, Marit Stjern4, Brian M Frier5, Kristian B Nilsen6. 1. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 2. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 3. Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. 4. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Section of Clinical Neurophysiology, Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 5. British Heart Foundation Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, U.K. 6. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway Section for Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Ullevål, Norway kristian.b.nilsen@ntnu.no.
Abstract
OBJECTIVE: Impaired awareness of hypoglycemia (IAH) is a risk factor for severe hypoglycemia in people with insulin-treated diabetes; autonomic neuropathy has been suggested to underlie its development. The aim was to evaluate a putative association between IAH and autonomic dysfunction using novel and sensitive measures of autonomic neural function. RESEARCH DESIGN AND METHODS: Sixty-six adults with type 1 diabetes were studied, 33 with IAH and 33 with normal awareness of hypoglycemia (NAH), confirmed by formal testing. Participants were matched for age, sex, and diabetes duration. Clinical and laboratory evaluations included extensive autonomic function testing, peripheral nerve conduction studies, and quantitative sensory testing. Composite abnormality Z scores were used for group comparisons. RESULTS: The IAH and NAH group had similar median (interquartile range) age of 48 (14.5) vs. 47 (14.5) years, diabetes duration of 30 (13.5) vs. 31 (13.5) years, and mean ± SD HbA1c 7.8 ± 2.2% vs. 8.1 ± 1.9%, respectively. The autonomic composite Z score did not differ between the two groups (mean difference -0.15, 95% CI -0.46, 0.16; P = 0.33), nor did the thermal detection (mean difference 0.15, 95% CI -0.31, 0.61; P = 0.51) or nerve conduction scores (mean difference 0.03, 95% CI -0.43, 0.49; P = 0.89). CONCLUSIONS: In adults with type 1 diabetes, IAH was not associated with autonomic dysfunction or peripheral neuropathy.
OBJECTIVE: Impaired awareness of hypoglycemia (IAH) is a risk factor for severe hypoglycemia in people with insulin-treated diabetes; autonomic neuropathy has been suggested to underlie its development. The aim was to evaluate a putative association between IAH and autonomic dysfunction using novel and sensitive measures of autonomic neural function. RESEARCH DESIGN AND METHODS: Sixty-six adults with type 1 diabetes were studied, 33 with IAH and 33 with normal awareness of hypoglycemia (NAH), confirmed by formal testing. Participants were matched for age, sex, and diabetes duration. Clinical and laboratory evaluations included extensive autonomic function testing, peripheral nerve conduction studies, and quantitative sensory testing. Composite abnormality Z scores were used for group comparisons. RESULTS: The IAH and NAH group had similar median (interquartile range) age of 48 (14.5) vs. 47 (14.5) years, diabetes duration of 30 (13.5) vs. 31 (13.5) years, and mean ± SD HbA1c 7.8 ± 2.2% vs. 8.1 ± 1.9%, respectively. The autonomic composite Z score did not differ between the two groups (mean difference -0.15, 95% CI -0.46, 0.16; P = 0.33), nor did the thermal detection (mean difference 0.15, 95% CI -0.31, 0.61; P = 0.51) or nerve conduction scores (mean difference 0.03, 95% CI -0.43, 0.49; P = 0.89). CONCLUSIONS: In adults with type 1 diabetes, IAH was not associated with autonomic dysfunction or peripheral neuropathy.
Authors: Andrew J Karter; E Margaret Warton; Kasia J Lipska; James D Ralston; Howard H Moffet; Geoffrey G Jackson; Elbert S Huang; Donald R Miller Journal: JAMA Intern Med Date: 2017-10-01 Impact factor: 21.873
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