Abstract：
Cardiovascular autonomic neuropathy (CAN) is suggested to underlie hypoglycaemic risk in impaired awareness of hypoglycaemia (IAH). We assessed the prevalence of CAN and the association between glucose variability (GV) and cardiovascular autonomic function in patients with type 1 diabetes (T1DM) and IAH. This study is a post-hoc-analysis of results obtained with the IN-CONTROL-trial, designed to assess the effects of continuous glucose monitoring (CGM) on glycaemia. Forty participants (aged 46.4 ± 11.4 years, diabetes duration 29.1 ± 13.5 years, HbA1c 7.5 ± 0.8%(58.2 ± 8.8 mmol/mol)) underwent 2-week blinded CGM measurements to obtain GV indices. Standardized cardiovascular reflex tests were used to determine the presence of CAN. Cardiovascular autonomic function was assessed with heart rate variability (HRV) measures. 14(35%) participants were classified as having CAN. Participants with CAN had lower percentage time spent in hypoglycaemic range and low blood glucose index(LBGI). After correction for confounders, a significant positive association was found between the coefficient of variation (CV) or time spent in hypoglycaemic range and HRV measures SDRR or RMSSD, and between LBGI and RMSSD. In patients with T1DM and IAH, hypoglycaemic parameters were associated with better cardiovascular autonomic function and lower prevalence of CAN. This suggests that autonomic neuropathy does not seem to further deteriorate hypoglycaemic risk in patients with IAH.
摘要：
心血管自主神经病变（CAN）被认为是低血糖意识受损（IAH）的低血糖风险的基础。我们评估了1型糖尿病（T1DM）和IAH患者中CAN的患病率以及葡萄糖变异性（GV）与心血管自主神经功能之间的关系。这项研究是对IN-CONTROL试验获得的结果的事后分析，旨在评估连续血糖监测（CGM）对血糖的影响。40名参与者（年龄46.4±11.4岁，糖尿病病程29.1±13.5年，HbA1c为7.5±0.8％（58.2±8.8mmol/mol）），进行2周盲CGM测量以获得GV指数。使用标准化的心血管反射测试来确定CAN的存在。使用心率变异性（HRV）评估心血管自主神经功能。14名（35%）参与者被归类为患有CAN。CAN患者在低血糖范围和低血糖指数（LBGI）中花费的时间百分比较低。校正混杂因素后，在低血糖范围内的变异系数（CV）或花费的时间与HRV措施SDRR或RMSSD之间发现了显着的正相关，在LBGI和RMSSD之间。在T1DM和IAH患者中，低血糖参数与较好的心血管自主神经功能和较低的CAN患病率相关。这表明自主神经病变似乎不会进一步恶化IAH患者的低血糖风险。
