Detection of early sympathetic cardiovascular neuropathy by squatting test in NIDDM.
OBJECTIVE
To determine the role of the squatting test in the detection of early sympathetic neuropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM).


METHODS
Three groups of nonsmoking, nonobese subjects were studied: 10 healthy subjects, 10 NIDDM patients without autonomic neuropathy (AN), and 10 NIDDM patients with AN defined by the presence of a pathological deep-breathing value. All subjects were given three postural tests: lying-to-standing, sitting-to-standing, and squatting test. Heart rate (HR) and finger arterial pressure were recorded with a noninvasive technique.


RESULTS
Blood pressure (BP) fall (expressed as decremental area) was not significantly different among the groups at standing up after sitting or lying. By contrast, a significantly greater BP drop occurred in NIDDM patients with AN (1,123 +/- 245 mm2) compared with NIDDM patients without AN (460 +/- 232 mm2) or normal subjects (429 +/- 138 mm2, P < 0.001). The HR increase after all the orthostatic maneuvers was smaller in diabetic patients with AN (P < 0.01) compared with that recorded in other groups. Significant correlations were observed between BP fall after squatting and either the expiration:inspiration ratio at deep breathing (r = -0.77, P < 0.001) or the duration of diabetes (r = 0.76, P < 0.001).


CONCLUSIONS
The intrinsic orthostatic load of the squatting test, which is greater than conventional postural maneuvers, makes the squatting test an easy and useful test to detect early orthostatic dysregulation in NIDDM.
Marfella
R
R
Department of Gerontology, Geriatrics, and Metabolic Diseases, Faculty of Medicine, Second University of Naples, Italy.
Salvatore
T
T
Giugliano
D
D
Di Maro
G
G
Giunta
R
R
Torella
R
R
Juchmes
J
J
Scheen
A
A
Lefebvre
P J
PJ
D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D009068:Movement; D011187:Posture; D012016:Reference Values; D012119:Respiration; D014636:Valsalva Maneuver