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Case Series
Assessment of autonomic neuropathy in type 1 diabetics by cardiovascular reflex testing and heart rate variability: A case series
1 Professor, Doctor of Medicine, Universidade Iguaçu - UNIG, Nova Iguaçu, Rio de Janeiro, Brazil
2 Medical Student, Universidade Iguaçu - UNIG, Nova Iguaçu, Rio de Janeiro, Brazil
3 Coordinator of the Undergraduate Physiotherapy, Universidade do Iguaçu, Nova Iguaçu, Rio de Janeiro, Brazil
4 Hospital Geral da Nova Iguaçu - Nova Iguaçu - RJ, Brazil; School of Medicine - UNIG - RJ, Brazil
Address correspondence to:
Antônio Marcos da Silva Catharino
Rua Gavião Peixoto 70, Room 811, CEP 24.2230-100, Icaraí, Niterói-RJ,
Brazil
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Article ID: 101301Z01AM2022
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Silveira MB, de Azeredo Siqueira R, Mafra AM, da Silva Catharino AM. Assessment of autonomic neuropathy in type 1 diabetics by cardiovascular reflex testing and heart rate variability: A case series. Int J Case Rep Images 2022;13:101301Z01AM2022.ABSTRACT
In this case series the authors are using data from a survey of two patients diagnosed more than five years ago with type 1 diabetes, patient 1 was symptomatic and patient 2 was asymptomatic for diabetic autonomic neuropathy. The heart rate variability (HRV) analysis involved time and frequency domains; for the time domain, with the indexes RR intervals between normal heartbeat (SDNN), pNN50, square root of the sum of the square of the difference between iRR (RMSSD). The HRV test showed that in the time domain, patient 1 presented a RMSSD slightly higher than the SDNN value, which means more vagal control over cardiac function; however, the PNN50% value did not indicate this parasympathetic activity. Patient 2, on the other hand, presented an SDNN higher than the RMSSD, indicating prevalence of sympathetic stimulation over the heart. When we look at the frequency domain, we can confirm the high influence of the parasympathetic system with a variable of high frequency (HF) higher than low frequency (LF), which represents sympathetic activity. In contrast, the asymptomatic patient showed prevalence of sympathetic activity with LF extremely higher than HF. In the analysis of the breath test and the waltz test, we observed an alteration in the result of the symptomatic patient, reaching a rate lower than expected for his age. On the other hand, the asymptomatic patient was above the expected rate. In conclusion, symptomatology is a striking feature in the diagnosis of diabetic autonomic neuropathy. Cardiovascular reflex tests are essential to close the diagnosis, and to evaluate and diagnose the asymptomatic cases that may be present.
Keywords: Cardiovascular system, Diabetes mellitus type 1, Diabetic neuropathies, Heart rate
SUPPORTING INFORMATION
Acknowledgments
Marília Salete Tavares – Physiotherapist at the School Clinic of Universidade Iguaçu. Julianne Ribeiro Braga – Aluna do curso de medicina na Universidade do Iguaçú.
Author ContributionsMichelli Brants Silveira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rodrigo de Azeredo Siqueira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Adalgiza Moreno Mafra - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Antônio Marcos da Silva Catharino - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Michelli Brants Silveira et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
