• Esteban Jorge-Galarza, Margarita Torres-Tamayo, Martínez-AlvaradoMaría Del RocíoMDREndocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico., Berenice Peña-Aparicio, Carmen González-Salazar, Juan Reyes-Barrera, Manuel Sierra-Beltrán, Erika Fajardo-Flores, Andrey Kostin, and J Antonio González-Hermosillo.
• Endocrinology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico.
• Ir J Med Sci. 2022 Oct 1; 191 (5): 207720842077-2084.

BackgroundAutonomic dysfunction is commonly observed in patients with long-standing type 2 diabetes. Previous studies have confirmed the value of both subjectively assessed symptoms and objective measurements of autonomic nervous system function in diagnosing cardiovascular autonomic neuropathy. However, the head-up tilt test (HUTT) has been rarely used to investigate cardiovascular autonomic responses in subjects with high risk of newly diagnosed type 2 diabetes (nT2D).ObjectiveTo evaluate autonomic cardiovascular responses through passive orthostatic challenge along the diabetes continuum.MethodsThe study population was stratified as normoglycemic (n = 16), prediabetes (n = 20), and nT2D (n = 20). The prevalence of orthostatic intolerance and autonomic cardiovascular responses was evaluated with the Task Force Monitor during a 30-min passive HUTT. Spectral indices of heart rate and blood pressure variability and baroreceptor effectiveness index (BEI) were calculated through the HUTT. BEI was obtained by the sequence method.ResultsThere were no differences in the prevalence of orthostatic intolerance or in the indices of heart rate and blood pressure variability among the three groups of study. The BEI was attenuated in the nT2D group in supine rest and throughout HUTT compared with normoglycemic and prediabetes groups. The multivariable linear regression analysis showed that BEI was associated with fasting glucose (β =  - 0.52, p  < 0.001) and HbA1c (β =  - 0.57, p  < 0.001) independently of cardiovascular risk factors.ConclusionCardiovascular autonomic neuropathy, expressed as blunted BEI, is the only abnormal autonomic nervous test detected in nT2D, and it was independently associated with fasting glucose and HbA1c values.© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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