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. 2008 Nov;25(11):1309-15.
doi: 10.1111/j.1464-5491.2008.02591.x.

New squatting test indices are useful for assessing baroreflex sensitivity in diabetes mellitus

M Nakagawa  1 , T Shinohara, F Anan, K Yufu, N Takahashi, N Okada, M Hara, H Yoshimatsu, T Saikawa
Affiliations

New squatting test indices are useful for assessing baroreflex sensitivity in diabetes mellitus

M Nakagawa et al. Diabet Med. 2008 Nov.

Abstract

Aims: The heart rate (HR) responses after performance of the squatting and standing manoeuvre are thought to be a useful tool to assess autonomic neuropathy in diabetics. Our aim was to develop new simple squatting test indices and to analyse their applicability to the assessment of baroreflex sensitivity (BRS) in patients with diabetes.

Methods: Twenty healthy volunteers (mean age 23.2 +/- 3.8 years) and 51 patients with diabetes (mean age 55.9 +/- 10.6 years) were enrolled in study 1 and study 2, respectively. Each subject stood for 3 min (basal period), then squatted down for 1 min (Sq) and stood up again for 1 min (St). In study 1, the squatting test was performed before and after pharmacological autonomic blockade. In study 2, we measured HR in each period and calculated the difference between basal HR and HRSq (DeltaHRSq) and between HRSt and HRSq (DeltaHRSt). BRS was also measured using the phenylephrine method in diabetic patients.

Results: In healthy individuals during autonomic blockade, HR changes were mainly controlled by the vagal tone during squatting and by the sympathetic tone during standing. In diabetic patients, DeltaHRSq and DeltaHRSt positively correlated (r = 0.86, P < 0.0001) and both DeltaHRSq and DeltaHRSt significantly correlated with BRS (r = 0.66, P < 0.0001 and r = 0.61, P < 0.0001, respectively).

Conclusions: The new squatting test indices provide useful information for assessing autonomic neuropathy and for identifying diabetic patients at high risk of cardiovascular events.

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Figures

Figure 1
Figure 1
Example of RR interval changes during the squatting test before and after autonomic blockade in a healthy subject. In the control study, the RR interval lengthened immediately after squatting and shortened after standing. Propranolol suppressed a decrease in RR intervals during the baseline and standing periods. The additional administration of atropine suppressed an increase in RR intervals during squatting.
Figure 3
Figure 3
Correlation between ΔHRSq and ΔHRSt. ΔHRSq and ΔHRSt showed a significant positive correlation in all diabetic patients (r = 0.86, P < 0.0001).
Figure 2
Figure 2
Baroreflex sensitivity (BRS) and RR interval changes during the squatting test. One 52-year-old diabetic man with normal BRS (14.1 ms/mmHg) showed remarkable changes in the RR interval during the squatting test (a, b). The other 52-year-old male diabetic patient who exhibited a very low BRS value (1.1 ms/mmHg) showed small RR interval changes during the squatting test (c, d).
Figure 5
Figure 5
Baroreflex sensitivity (BRS) and squatting test results in diabetic patients. The diabetic patients were divided into three groups based on their ΔHRSq and ΔHRSt values. Patients with fewer than 2 b.p.m. at ΔHRSq or fewer than 5 b.p.m. at ΔHRSt had very low BRS values.
Figure 4
Figure 4
Correlation between squatting test results and baroreflex sensitivity (BRS). Both ΔHRSq (r = 0.66, P < 0.0001) and ΔHRSt (r = 0.61, P < 0.0001) showed a significant correlation with BRS in diabetic patients.
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