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Comparative Study
. 2024 Nov;48(6):1114-1125.
doi: 10.4093/dmj.2023.0301. Epub 2024 Feb 26.

Does the Relationship of the Autonomic Symptoms Questionnaire COMPASS 31 with Cardiovascular Autonomic Tests Differ between Type 1 and Type 2 Diabetes Mellitus?

Ilenia D'Ippolito  1 , Marika Menduni  1 , Cinzia D'Amato  1 , Aikaterini Andreadi  1 , Davide Lauro  1 , Vincenza Spallone  1
Affiliations
Comparative Study

Does the Relationship of the Autonomic Symptoms Questionnaire COMPASS 31 with Cardiovascular Autonomic Tests Differ between Type 1 and Type 2 Diabetes Mellitus?

Ilenia D'Ippolito et al. Diabetes Metab J. 2024 Nov.

Abstract

Backgruound: The aim was to investigate if autonomic symptoms questionnaire Composite Autonomic Symptom Score (COMPASS) 31 has different association with cardiovascular autonomic neuropathy (CAN) and diagnostic performance between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Methods: Seventy-nine participants with T1DM and 140 with T2DM completed COMPASS 31 before cardiovascular reflex tests (CARTs) for CAN, and assessment of symptoms, signs, vibration, and thermal perception thresholds for diabetic polyneuropathy (DPN) diagnosis.

Results: COMPASS 31 total weighted score (TWS) was similar in the two groups, but significantly associated with confirmed CAN only in T1DM (P=0.0056) and not T2DM group (P=0.1768) and correlated with CARTs score more strongly in T1DM (rho=0.356, P=0.0016) than in T2DM group (rho=0.084, P=0.3218) (P=0.016). Only in T1DM and not T2DM group, the area under the receiver operating characteristic curve (AUC) reached a fair diagnostic accuracy (>0.7) for confirmed CAN (0.73±0.07 vs. 0.61±0.08) and DPN (0.75±0.06 vs. 0.68±0.05), although without a significant difference. COMPASS 31 TWS (cut-off 16.44) reached acceptable diagnostic performance in T1DM, with sensitivity for confirmed CAN 81.2% and sensitivity and specificity for DPN 76.3% and 78%, compared to T2DM group (all <70%). AUC for DPN of orthostatic intolerance domain was higher in T1DM compared to T2DM group (0.73±0.05 vs. 0.58±0.04, P=0.027).

Conclusion: COMPASS 31 is more weakly related to CAN in T2DM than in T1DM, with a fair diagnostic accuracy for confirmed CAN only in T1DM. This difference supports a multifactorial origin of symptoms and should be considered when using COMPASS 31.

Keywords: Autonomic nervous system diseases; Diabetes mellitus, type 1; Diabetes mellitus, type 2; Diabetic neuropathies; Diagnosis; Neurologic manifestations; Orthostatic intolerance.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Spearman’s rank correlation coefficients of Composite Autonomic Symptom Score (COMPASS) 31 total weighted score (TWS) with cardiovascular autonomic reflex tests (CARTs) score in (A) type 1 diabetes mellitus (T1DM) and (B) type 2 diabetes diabetes mellitus (T2DM). There was a significant difference of the correlations in T1DM and T2DM groups (P=0.016).
Fig. 2.
Fig. 2.
(A) Receiver operating characteristic (ROC) plots for Composite Autonomic Symptom Score (COMPASS) 31 total weighted score (TWS) in distinguishing between participants with and without overall cardiovascular autonomic neuropathy (CAN). (B) ROC plot for COMPASS 31 TWS in distinguishing between participants with and without confirmed CAN. (C) ROC plot for COMPASS 31 TWS in distinguishing between participants with and without diabetic polyneuropathy (DPN). Participants with type 1 diabetes mellitus (T1DM; in blue) and type 2 diabetes mellitus (T2DM; in red). No significant differences of area under the receiver operating characteristic curves (AUCs) between T1DM and T2DM for overall CAN (chi-square=0.02, P=0.890), confirmed CAN (chi-square=1.26, P=0.262), and DPN (chi-square=0.90, P=0.343) were reached. CI, confidence interval.
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References

    1. Valensi P, Paries J, Attali JR, French Group for Research and Study of Diabetic Neuropathy Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications: the French multicenter study. Metabolism. 2003;52:815–20. - PubMed
    1. Chen HT, Lin HD, Won JG, Lee CH, Wu SC, Lin JD, et al. Cardiovascular autonomic neuropathy, autonomic symptoms and diabetic complications in 674 type 2 diabetes. Diabetes Res Clin Pract. 2008;82:282–90. - PubMed
    1. Chyun DA, Melkus GD, Katten DM, Price WJ, Davey JA, Grey N, et al. The association of psychological factors, physical activity, neuropathy, and quality of life in type 2 diabetes. Biol Res Nurs. 2006;7:279–88. - PubMed
    1. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93. - PMC - PubMed
    1. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, PopBusui R, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27:639–53. - PubMed

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