Short-term postural reflexes in diabetic patients with autonomic dysfunction

Abstract

Aims/hypothesis: Assessment of autonomic dysfunction provides prognostic data in diabetic patients. Clinical tests are limited to heart rate variability and blood pressure measurements. We investigated whether a detailed analysis of postural reflexes of patients during short-term head-up tilting and standing erect (both for 3 min) would provide useful clinical data.

Methods: We studied 14 control subjects and 56 patients with Type 2 diabetes, stratified into four matched groups: uncomplicated, micro-albuminuria, macro-albuminuria and autonomic neuropathy, who were tilted 55 degrees three times and were standing erect. Non-invasive finger plethysmography blood pressure measurements, using the Portapres, and impedance cardiac output measurements, using the RheoCardioMonitor, were continuously recorded throughout the study. Wavelets of the response to tilting and standing were drawn. The wavelets for the three tilts were combined to improve definition. The degree of autonomic dysfunction was quantified by calculating the baroreflex sensitivity index from the heart-rate and blood-pressure variability data.

Results: Baroreflex sensitivity data confirmed that autonomic dysfunction increased as diabetic complications worsened (p<0.001). Both standing and tilting resulted in an initial decrease in blood pressure followed by recovery, an increase in heart rate which was more pronounced with standing and a decrease in stroke volume. Characteristic and incremental changes in these responses were noted as the complications of diabetes worsened (p<0.001). These were a greater decrease in blood pressure with loss of the recovery phase, a reduced heart-rate response and paradoxically an increase in stroke volume.

Conclusion/interpretation: Non-invasive blood-pressure and stroke-volume measurements recorded during short-term tilting and standing promises to be useful in assessing diabetic autonomic dysfunction.