[Autonomic nervous dysfunction in insulin-dependent (type 1) diabetic men.].
The development of autonomic nervous dysfunction (AND) in subjects with diabetes influences life expectancy and may cause sudden death. The present study evaluates disturbances of AND in 41 men with type 1 diabetes mellitus, but without heart symptoms, and the relationship with other long term diabetic complications and blood sugar control. Their age ranged 18-50 years (mean 34 +/-8 years) and the duration of diabetes 1-43 years (mean 13 +/-10 years). A control group consisted of 18 healthy men of similar age. Heart rate and blood pressure responses during standard autonomic tests were assessed by a computer program, vibration sensibility by a Biothesiometer, and an exercise test was performed. AND was more frequent in diabetics than controls (39% versus 6%, p<0.01), and increased with the duration of diabetes (r=0.34, p<0.05), but not significantly with HbAl-levels (r=0.21, p=0.19). Diabetics with AND had an earlier onset p<0.05) and a longer duration of (p<0.01) diabetes, decreased vibration sense (p<0.05), more frequent hypoglycaemic episodes (p<0.05), intermittent claudication (p<0.01), a higher resting heart rate (p<0.05), and a shorter treadmill time (p<0.05). Consequently, at maximal exercise their systolic (p<0.05) and diastolic (p=0.08) blood pressure increased less. With longer duration of diabetes, retinopathy (p<p.001), vibration sense p<0.05), and AND (p<0.05) all worsened. The same held for a total score of nervous, eye and kidney complications (r=0.75, p<0.001), which however was not related to HbAl values. In conclusion, type 1 diabetics often have disturbances of the autonomic and peripheral nervous system that may be without symptoms and increase with the duration of diabetes.
Olafsson
G
G
Danielsen
R
R
Hreidarsson
A B
AB