title: Cardiovascular Variability Analysis and Baroreflex Estimation in Patients with Type 2 Diabetes in Absence of Any Manifest Neuropathy.
abstract: Indexes derived from spontaneous heart period (HP) and systolic arterial pressure (SAP) fluctuations can detect autonomic dysfunction in individuals with type 2 diabetes mellitus (DM) associated to cardiovascular autonomic neuropathy (CAN) or other neuropathies. It is unknown whether HP and SAP variability indexes are sensitive enough to detect the autonomic dysfunction in DM patients without CAN and other neuropathies.
  
  
  
  We evaluated 68 males aged between 40 and 65 years. The group was composed by DM type 2 DM with no manifest neuropathy (n = 34) and healthy (H) subjects (n = 34). The protocol consisted of 15 minutes of recording of HP and SAP variabilities at rest in supine position (REST) and after active standing (STAND). The HP power in the high frequency band (HF, from 0.15 to 0.5 Hz), the SAP power in the low frequency band (LF, from 0.04 to 0.15 Hz) and BRS estimated via spectral approach and sequence method were computed.
  
  
  
  The HF power of HP was lower in DM patients than in H subjects, while the two groups exhibited comparable HF power of HP during STAND. The LF power of SAP was similar in DM and H groups at REST and increased during STAND in both groups. BRSs estimated in the HF band and via baroreflex sequence method were lower in DM than in H and they decreased further during STAND in both populations.
  
  
  
  Results suggest that vagal control of heart rate and cardiac baroreflex control was impaired in type 2 DM, while sympathetic control directed to vessels, sympathetic and baroreflex response to STAND were preserved. Cardiovascular variability indexes are sensitive enough to typify the early, peculiar signs of autonomic dysfunction in type-2 DM patients well before CAN becomes manifest.
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Sílvia Cristina Garcia
authors.initials: SC
authors.lastname: de Moura-Tonello
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.|Department of cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Porta
authors.affiliation: Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marchi
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Alessandra
authors.initials: A
authors.lastname: de Almeida Fagundes
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Cristina de Oliveira
authors.initials: Cde O
authors.lastname: Francisco
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Rehder-Santos
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Juliana Cristina
authors.initials: JC
authors.lastname: Milan-Mattos
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Rodrigo Polaquini
authors.initials: RP
authors.lastname: Simões
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Mariana de Oliveira
authors.initials: Mde O
authors.lastname: Gois
authors.affiliation: Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
authors.forename: Aparecida Maria
authors.initials: AM
authors.lastname: Catai
mesh_terms: D000328:Adult; D000368:Aged; D017704:Baroreflex; D002319:Cardiovascular System / Q000294:innervation* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged