Association of Cardiovascular Autonomic Neuropathy and Distal Symmetric Polyneuropathy with All-Cause Mortality: A Retrospective Cohort Study

• Main Authors: Orsolya E. Vági, Márk M. Svébis, Beatrix A. Domján, Anna E. Körei, Ildikó Istenes, Zsuzsanna Putz, Szilvia Mészáros, Noémi Hajdú, Magdolna Békeffy, Solomon Tesfaye, Péter Kempler, Viktor J. Horváth, Adam G. Tabák
• Format: Article
• Language: English
• Published: Hindawi Limited 2021-01-01
• Series: Journal of Diabetes Research
• Online Access: http://dx.doi.org/10.1155/2021/6662159

Background. People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. However, the association between distal symmetric polyneuropathy (DSPN) or CAN with all-cause mortality is much less investigated. Thus, we set out to examine the effect of CAN and DSPN on all-cause mortality in a well-phenotyped cohort. Methods. All diabetes cases (n=1,347) from the catchment area of a secondary diabetes care centre who had medical examination including neuropathy assessment between 1997 and 2016 were followed up for all-cause mortality in the NHS Hungary reimbursement database until 2018. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type. Results. Altogether, n=131/1,011 persons with type 1/type 2 diabetes were included. Of the participants, 53%/43% were male, mean age was 46±12/64±10 years, diabetes duration was 13±10/7±8 years, 42%/29% had CAN, and 39%/37% had DSPN. During the 9±5/8±5-year follow-up, n=28/494 participants died. In fully adjusted models, participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. In type 2 diabetes, both DSPN and CAN independently increased mortality (HR 1.32, 95% CI: 1.07-1.64, and HR 1.44, 95% CI: 1.17-1.76). Conclusions. Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. Furthermore, we report a similarly strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus.