The association between insulin resistance and diabetic autonomic neuropathy in diabetic patients

M.P. Koukouli, A. Melidonis, E. Bilianou, I. Skoularigis, H. Zintzaras, F. Triposkiadis



AIM: Diabetic Autonomic Neuropathy (DAN) consists a serious complication of diabetes, commonly occurring as a result of hyperglycemia and other factors. The evidence already published in the literature has not clarified the contribution of insulin resistance in DAN. The current study aims to explore the association between those two implications.
MATERIAL-METHODS: 55 patients diagnosed with diabetes type 2 (26 women and 29 men), who attended the Diabetes Center, participated to the study. Information on physical characteristics and medical history was collected and laboratory tests were performed. Insulin resistance was assessed by HOMA (Homeostasis Model Assessment). DAN was evaluated according to four specialized tests: heart-rate variation during deep breathing, heart-rate variation from lying to standing, Valsalva and blood pressure variation from lying to standing. Those who were found pathological to two or more of the above mentioned tests, were considered to suffer from DAN. Data were analyzed with univariate and multivariate logistic regression, after adjustment for possible risk factors, such as gender, age, Body Mass Index (BMI), waist-to-hip ratio, microalbuminuria and diabetes duration. The independent variable HOMA was introduced in statistical models both as a continuous and as a categorical variable (by quartiles).
RESULTS: The mean age was 58.56 ± 9.87 years, mean diabetes duration 7.94 ± 7.06 years, mean BMI 30.05 ± 5.37 kg/m2, mean waist-to-hip ratio 0.93 ± 0.08 cm and the average levels of HOMA 82.70 ± 64.92 mU/L*mg/dL. 31 (56.4%) participants suffered from DAN. After adjusting for potential risk factors, we found no evidence for a possible association between HOMA and DAN, either HOMA presented in continuous (odds ratio, OR=1.00, p=0.31) or in categorical form (OR=0.88, p=0.69). Further evaluation of individual specialized tests of DAN did not reveal any possible correlation.
CONCLUSION: According to the findings of the current study, there was no evidence for a possible association between insulin resistance and DAN in diabetic patients.