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The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review
AIMS/HYPOTHESIS: Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolera...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801295/ https://www.ncbi.nlm.nih.gov/pubmed/33164108 http://dx.doi.org/10.1007/s00125-020-05316-z |
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author | Eleftheriadou, Aikaterini Williams, Scott Nevitt, Sarah Brown, Emily Roylance, Rebecca Wilding, John P. H. Cuthbertson, Daniel J. Alam, Uazman |
author_facet | Eleftheriadou, Aikaterini Williams, Scott Nevitt, Sarah Brown, Emily Roylance, Rebecca Wilding, John P. H. Cuthbertson, Daniel J. Alam, Uazman |
author_sort | Eleftheriadou, Aikaterini |
collection | PubMed |
description | AIMS/HYPOTHESIS: Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. METHODS: This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. RESULTS: Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. CONCLUSIONS/INTERPRETATION: There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition. [Figure: see text] SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s00125-020-05316-z) contains peer-reviewed but unedited supplementary material, which is available to authorised users. |
format | Online Article Text |
id | pubmed-7801295 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-78012952021-01-21 The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review Eleftheriadou, Aikaterini Williams, Scott Nevitt, Sarah Brown, Emily Roylance, Rebecca Wilding, John P. H. Cuthbertson, Daniel J. Alam, Uazman Diabetologia Article AIMS/HYPOTHESIS: Cardiac autonomic neuropathy (CAN) is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Several studies have highlighted the increased prevalence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Considering the exponential rise of prediabetes, we aimed to determine the prevalence of CAN through a systematic literature review. METHODS: This systematic review was registered with PROSPERO (CRD42019125447). An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, Scopus and Cochrane databases. Published full text, English language articles that provide CAN prevalence data of studies in individuals with prediabetes and aged over 18 years were included. Prevalence data for normal glucose tolerance and diabetes were also extracted from the selected articles, if present. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using a critical appraisal tool. RESULTS: Database searches found 4500 articles; subsequently, 199 full text articles were screened, 11 of which fulfilled the inclusion criteria (4431 total participants, 1730 people with prediabetes, 1999 people with normal glucose tolerance [NGT] and 702 people with predominantly type 2 diabetes). Six of the selected studies reported definite CAN prevalence data (9–39%). Only a single large population-based study by Ziegler et al (KORA S4 study, 1332 participants) determined definite CAN based on two or more positive autonomic function tests (AFTs), with a mean prevalence of 9% in all prediabetes groups (isolated impaired glucose tolerance 5.9%; isolated impaired fasting glucose 8.1%; impaired fasting glucose plus impaired glucose tolerance 11.4%), which was higher than NGT (4.5%). This study is most likely to provide a reliable population-specific estimate of CAN in prediabetes. There was a higher than expected prevalence of CAN in prediabetes (9–38%) when compared with normal glucose tolerance (0–18%) within the same studies (n = 8). There was a wide prevalence of possible CAN based on one positive AFT (n = 5). There was heterogeneity between the studies with variations in the definition of CAN, methodology and characteristics of the populations, which likely contributed to the diversity of prevalence estimates. The overall risk of bias was low. CONCLUSIONS/INTERPRETATION: There is a higher than expected prevalence of CAN in prediabetes. Early detection of CAN in prediabetes through population screening needs careful consideration in view of the excess morbidity and mortality risk associated with this condition. [Figure: see text] SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s00125-020-05316-z) contains peer-reviewed but unedited supplementary material, which is available to authorised users. Springer Berlin Heidelberg 2020-11-09 2021 /pmc/articles/PMC7801295/ /pubmed/33164108 http://dx.doi.org/10.1007/s00125-020-05316-z Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Eleftheriadou, Aikaterini Williams, Scott Nevitt, Sarah Brown, Emily Roylance, Rebecca Wilding, John P. H. Cuthbertson, Daniel J. Alam, Uazman The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title | The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title_full | The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title_fullStr | The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title_full_unstemmed | The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title_short | The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
title_sort | prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801295/ https://www.ncbi.nlm.nih.gov/pubmed/33164108 http://dx.doi.org/10.1007/s00125-020-05316-z |
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