Diabetes Mellitus, Type 1

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Letter to the Editor

Cardiac Autonomic Functions May be Influenced by Body Weight

To the Editor,

I read the paper by Silva et al. entitled ‘‘Sensitivity, Specificity and Predictive Value of Heart Rate Variability Indices in Type 1 Diabetes Mellitus’’ published in Arquivos Brasileiros de Cardiologia in March 2017. They aimed to compare Heart Rate Variability (HRV) indices and evaluate their sensitivity, specificity, and predictive value in young type 1 diabetic patients and healthy volunteers. It was showed a decrease in sympathetic and parasympathetic activities, as well as overall variability of autonomic nervous system in the diabetic group. I would like to congratulate Silva et al. for their valuable effort in this study. I also have a few comments to do.

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Artigo Original

Microvascular complications and cardiac autonomic dysfunction in patients with diabetes mellitus type 1

Fernando K Almeida et al. Jorge L Gross Ticiana C Rodrigues

BACKGROUND: The presence of cardiac autonomic neuropathy (CAN) in patients with diabetes mellitus (DM) is associated with increased mortality and chronic microvascular complications of diabetes. OBJECTIVE: To investigate a possible association between specific findings of CAN during exercise testing (ET) and nephropathy and retinopathy in patients with type 1 DM. METHODS: We conducted a cross-sectional study of 84 patients with type 1 DM. All patients underwent clinical laboratory evaluation and performed ET, and those who presented findings suggesting myocardial ischemia were excluded from data analysis (n = 3). The assessment of microvascular complications (retinopathy and nephropathy) was performed in the sample. RESULTS: Patients with nephropathy and those with retinopathy achieved a lower heart rate (HR) at peak exercise (HR max) and smaller increase in HR in relation to rest (Peak ΔHR) compared with those without these complications. These patients also had a smaller reduction in HR in the second and 4th minutes after the end of the test (ΔHR recovery 2 and 4 minutes). After performing a multivariate analysis with control for possible confounding factors, the ΔHR recovery in two and four minutes, maximum HR and Peak ΔHR remained significantly associated with retinopathy; and ΔHR recovery in the second and 4th minutes remained associated with the presence of nephropathy. CONCLUSION: The ET can be considered an additional tool for early detection of CAN and to identify patients at increased risk for microvascular complications of diabetes.

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Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis

Dinaldo Cavalcanti de Oliveira et al. Fabio Sandoli de Brito Junior Rosley Weber Alvarenga Fernandes João Roberto de Sa Valter Correia de Lima

BACKGROUND: In patients with type 1 diabetes mellitus, atherosclerosis occurs earlier in life and coronary artery disease (CAD) constitutes the major cause of death. OBJECTIVE: Evaluate the prevalence and anatomic characteristics of coronary artery disease (CAD) in type 1 diabetic patients with chronic renal failure undergoing hemodialysis. METHODS: This is a descriptive study of 20 patients with type 1 diabetes mellitus undergoing hemodialysis without known CAD. CAD was assessed by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). QCA was performed in all lesions >30%, visually. All proximal 18-mm segments of the coronary arteries were analyzed by IVUS. All other coronary segments with stenosis >30% were also analyzed. RESULTS: Angiography detected 29 lesions >30% in 15 patients (75%). Eleven (55%) of the lesions were >50% and 10 (50%) >70%. Thirteen patients had all 3 major arteries interrogated by IVUS. Atherosclerosis was present in all patients and in all 51 proximal 18-mm segments analyzed. The mean vessel diameter of these segments was significantly larger at the IVUS than at the QCA, for all vessels. IVUS images of 25 (86.2%) of the 29 lesions >30% were obtained. Fibrotic plaques were common (48%) and 60% had intermediate vessel remodeling. CONCLUSION: CAD was present in all vessels of all type 1 diabetic patients undergoing hemodialysis. These findings are in agreement with other autopsy, angiography and IVUS studies. Additionally, they indicate the need for additional epidemiological and imaging studies to better understand and treat such a complex and serious clinical condition affecting young people.

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Cardiac Autonomic Functions May be Influenced by Body Weight

Microvascular complications and cardiac autonomic dysfunction in patients with diabetes mellitus type 1

Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis

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