Symptomatic diabetic autonomic neuropathy common in adults with type 1 diabetes
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About one in five adults with type 1 diabetes reports having symptomatic diabetic autonomic neuropathy, according to study findings published in the Journal of Diabetes and Its Complications.
In findings from participants in the T1D Exchange clinic registry, adults who reported experiencing symptomatic diabetic autonomic neuropathy had higher risks for conditions ranging from cardiovascular disease and diabetic peripheral neuropathy to depression and opioid use when compared with those who did not report neuropathy.
“Although we have very sophisticated tools to assess for autonomic neuropathy, many of these tests are time-consuming, expensive and clinically impractical,” Kara Mizokami-Stout, MD, MSc, assistant professor of internal medicine in the division of metabolism, endocrinology and diabetes at the University of Michigan, told Healio. “In this study, we wanted to understand the symptoms that patients with type 1 diabetes experience as a potential result of autonomic neuropathy. These symptoms matter most to patients, as they affect quality of life and are an important springboard to facilitate a conversation between clinicians and patients on management to improve both glycemic and nonglycemic risk factors for autonomic neuropathy.”
Mizokami-Stout and colleagues collected data from 965 adults with type 1 diabetes participating in the T1D Exchange who completed a survey in February 2018 (64% women; 90% white; mean age, 40 years). Questionnaires were used to collect demographic data. The survey of autonomic symptoms was used to determine the presence and severity of diabetic autonomic neuropathy, with a higher score indicating worse symptoms. Participants who had a score higher than 3 of 11 points for women or 3 of 12 points for men were classified as having symptomatic diabetic autonomic neuropathy. Those with the condition were divided into severity categories of mild, moderate, severe and very severe using the 25th, 50th and 75th percentiles of the survey score.
Of the study cohort, 17% reported having symptomatic diabetic autonomic neuropathy. Mean HbA1c was higher in those with neuropathy and increased as severity of symptoms increased. Participants with neuropathy were more likely to report at least one severe hypoglycemic event (OR = 2.59; P = .002) and at least one diabetic ketoacidosis event (OR = 2.86; P = .05) in the 3 months before the survey compared with those without diabetic autonomic neuropathy.
Compared with those who did not have symptomatic diabetic autonomic neuropathy, adults with neuropathy had increased risks for CVD (OR = 1.51; P = .02), gastroparesis (OR = 2.32; P < .001) and diabetic peripheral neuropathy (OR = 3.41; P < .001). Those with neuropathy were also more likely to use opioids (OR = 1.99; P = .004), report anxiety (OR = 1.34; P = .03), report depression (OR = 1.47; P < .001) and have a lower annual income (P = .03) compared with those without neuropathy.
“Although prior studies have suggested the importance of cardiovascular risk factors, our study is among the first to find associations between symptomatic diabetic autonomic neuropathy and socioeconomic factors and psychological factors,” Mizokami-Stout said.
Mizokami-Stout said more research must be done on how socioeconomic and psychological factors interact with glycemic and metabolic management in type 1 diabetes.
“We know that the high cost of therapies, such as insulin, impose a significant financial burden for those with type 1 diabetes and that impacts short-term outcomes such as glycemic control,” Mizokami-Stout said. “However, the longer-term effects on diabetes complications, psychological outcomes and quality of life need further exploration; this will offer a more complete picture on the true burdens that our patients with type 1 diabetes bear.”
For more information:
Kara Mizokami-Stout, MD, MSc, can be reached at kmizokam@med.umich.edu.
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