Comparison of Autonomic Neuropathic Changes in Type 1 and Type 2 Diabetes Mellitus

Introduction: Diabetes is the most common endocrine metabolic disorder. Duration of Diabetes affects the quality and longevity. Autonomic neuropathy is postulated to be an indicator of impending demise. Aims & Objectives: The aim of the present study was to compare the autonomic nervous system activity between Type 1 and Type 2 diabetes mellitus and with normal control subjects and to evaluate the effect of duration of disease. Materials and Methods: The present study was conducted on 100 Diabetics attending the diabetic clinic of Guru Nanak Dev hospital Amritsar and 25 healthy attendants served as controls. The patients were divided into two major groups i.e. Type 1 and Type 2 diabetes and two subgroups(<5 years of duration, >5 years of duration). Autonomic nervous system activity was assessed in the physiology department. Sympathetic activity was measured by cold presser test, hand grip test, and blood pressure response to standing. Parasympathetic activity was measured by S/L ratio, 30/15 ratio, valsalva ratio and I/E ratio. The results were statistically analyzed. Results: Changes in sympathetic activity as observed by changes in SBP, CPT & HGT were significantly (p<0.001) affected by type of diabetes (Type 1 DM vs Type 2 DM) and by the duration of disease (<5 yrs vs >5yrs) as compared to normal. Significant changes in parasympathetic activity (30: 15 ratio, DBT, S/L ratio) were observed in diabetics as compared to normal which progressed with duration of disease (<5 yrs vs >5yrs, p<0.05) but were similar in both types of diabetes. Conclusion: With early detection of Autonomic neuropathy, use of aggressive approach in management of Diabetes Mellitus would reduce mortality and morbidity in these patients.