[en] OBJECTIVE--To determine the role of the squatting test in the detection of early sympathetic neuropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS--Three groups of nonsmoking, nonobese subjects were studied: 10 healthy subjects, 10 NIDDM patients without autonomic neuropathy (AN), and 10 NIDDM patients with AN defined by the presence of a pathological deep-breathing value. All subjects were given three postural tests: lying-to-standing, sitting-to-standing, and squatting test. Heart rate (HR) and finger arterial pressure were recorded with a noninvasive technique. RESULTS--Blood pressure (BP) fall (expressed as decremental area) was not significantly different among the groups at standing up after sitting or lying. By contrast, a significantly greater BP drop occurred in NIDDM patients with AN (1,123 +/- 245 mm2) compared with NIDDM patients without AN (460 +/- 232 mm2) or normal subjects (429 +/- 138 mm2, P < 0.001). The HR increase after all the orthostatic maneuvers was smaller in diabetic patients with AN (P < 0.01) compared with that recorded in other groups. Significant correlations were observed between BP fall after squatting and either the expiration:inspiration ratio at deep breathing (r = -0.77, P < 0.001) or the duration of diabetes (r = 0.76, P < 0.001). CONCLUSIONS--The intrinsic orthostatic load of the squatting test, which is greater than conventional postural maneuvers, makes the squatting test an easy and useful test to detect early orthostatic dysregulation in NIDDM.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Marfella, R.
Salvatore, T.
Giugliano, D.
Di Maro, G.
Giunta, R.
Torella, R.
Juchmes, J.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Lefebvre, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Language :
English
Title :
Detection of early sympathetic cardiovascular neuropathy by squatting test in NIDDM.
Publication date :
1994
Journal title :
Diabetes Care
ISSN :
0149-5992
eISSN :
1935-5548
Publisher :
American Diabetes Association, Alexandria, United States - Virginia
O'Brien IAD, O'Hare P, Roger JMC: Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. Br Heart J 55:348-54, 1986
Parati G, Casadei R, Groppelli A, Di Rienzo M, Mancia G: Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension 13:647-55, 1989
Borst C, Van Brederode JFM, Wieling W, Van Montfrans GA, Dunning AJ: Mechanisms of initial blood pressure response to postural change. Clin Sci 67:321-27, 1984
Rossberg F, Penaz J: Initial cardiovascular response on change of posture from squatting to standing. Eur J Appl Physiol 57:93-97, 1988
Ewing DJ, Clarke BF: Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 9:648-65, 1986
Bellavere F, Balzani I, De Masi G, Carraro M, Carenza P, Cobelli C, Thomaseth K: Power spectral analysis of heart rate variations improves assessment of diabetic autonomic neuropathy. Diabetes 41: 633-40, 1992