Otonom Diyabetik Nöropati ile Glisemik Kontrol Arasındaki İlişki

Öz

Amaç: Tip 2 diabetes mellituslu (DM) hastalarda gastrointestinal ve kardiyovasküler diyabetik otonomik nöropatinin değerlendirilmesi amaçlanmaktadır.

Materyal ve Metot: DM hastalarından oluşan çalışma grubu Mart-Eylül 2012 tarihleri arasında incelendi. Yaş, vücut kütle indeksi (VKİ), açlık kan glukozu, HbA1c, C-peptid, diyabet süresi, elektrokardiyogram, kan basıncı, kalp hızı kaydedildi. Hastalar kontrol altında olan ve olmayan diyabetikler olarak gruplandırıldı. Kardiyak otonom nöropati (KON) testleri değerlendirildi. Anal manometri ile rekto-anal inhibitör refleks, istirahat ve sıkma basınçları ölçüldü.

Bulgular: Toplam 50 DM hastası çalışmaya kaydedildi ve hastaların yaş ortalaması 57,06±8,92 yıl, istirahat anal basıncı ortalaması 55,92±14,84 mmHg ve sıkma anal basıncı ortalaması 83,15±31,00 mmHg idi. Orta ve ağır KON grupları arasında istirahat anal basıncında anlamlı fark saptanmazken (p=0,573), orta ve ağır KON grupları arasında maksimum sıkma basıncında anlamlı fark mevcuttu (p=0,005). Kısa veya uzun süreli diyabeti olan hastalarda anal manometrik basınçlarda fark saptanmadı. KON ile VKİ arasında ilişki bulunmazken yaş ile ilişki saptandı. Kötü glisemik kontrol istirahat basında azalma ile ilişkili iken, maksimum sıkma basıncı ve yetersiz glisemik kontrol grubu arasında ilişki yoktu. KON’un şiddeti maksimum sıkma basıncında azalma ile ilişkiliydi.

Sonuç: Kardiyak ve gastrointestinal otonom disfonksiyon, DM’nin önemli komplikasyonlarıdır. Anal manometri testleri ve KON diyabetin bu komplikasyonlarını gösterebilir. 

Anahtar Kelimeler

• Manometre,tip 2 diabetes mellitus,diyabetik otonom nöropati

Relationship Between Autonomic Diabetic Neuropathy and Glycemic Control

Abstract

Objectives: To assess gastrointestinal and cardiovascular diabetic autonomic neuropathy in patients with type 2 diabetes mellitus (DM).

Materials and Methods: The study group composed of DM patients examined between March and September 2012. Age, body mass index (BMI), fasting blood glucose, HbA1c, C–peptide, duration of diabetes, electrocardiogram, blood pressure, heart rate were recorded. Patients were grouped as controlled and uncontrolled diabetics. Cardiac autonomic neuropathy (CAN) tests were done. Rectoanal inhibitory reflex, resting and squeeze pressures were measured by anal manometry.

Results: A total of 50 DM patients were enrolled and the mean age of patients was 57.06±8.92 years, the mean resting anal pressure was 55.92±14.84 mmHg, and squeezing anal pressure was 83.15±31.00 mmHg. There was no significantly different resting anal pressure between mild and severe CAN groups (p=0.573), but maximum squeezing pressure was significantly different between mild and severe CAN groups (p=0.005). Anal manometric pressures were not different in patients with short or long duration of diabetes. BMI was not associated with CAN, whereas age was. Bad glycemic control was associtated with a decrease in resting pressures, but no significant difference between maximum squeeze pressures and insufficient glycemic control groups. Severity of CAN was associated with a decrease in maximum squeeze pressures.

Conclusion: Cardiac and gastrointestinal autonomic dysfunction are important complications of DM. Anal manometric tests and CAN may show these complications of diabetes. 

Keywords

• Manometry,type 2 diabetes mellitus,diabetic autonomic neuropathy

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