title: Diabetic neuropathy is a more important determinant of baroreflex sensitivity than carotid elasticity in type 2 diabetes.
abstract: The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25+/-2.80 ms/mm Hg versus 7.55+/-3.79 ms/mm Hg; P<0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (r2=0.08, P=0.04 and r2=0.04, P=0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1+/-0.5 versus 6.1+/-0.4 ms/mm Hg, respectively; P=0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratio=5.1, P=0.028 versus F ratio=1.9, P=0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.
authors.affiliation: Department of Endocrinology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz
authors.forename: David
authors.initials: D
authors.lastname: Monbaron
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Sophie
authors.initials: S
authors.lastname: Perret
authors.forename: Erik
authors.initials: E
authors.lastname: Haesler
authors.forename: Claude
authors.initials: C
authors.lastname: Danzeisen
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayoz
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D050197:Atherosclerosis / Q000209:etiology*; D001341:Autonomic Nervous System / Q000503:physiopathology; D017704:Baroreflex; D002339:Carotid Arteries / Q000503:physiopathology*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000209:etiology*; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis