Otonom Diyabetik Nöropati ile Glisemik Kontrol Arasındaki İlişki

Yıl 2017, Cilt: 17 Sayı: 4, 245 - 252, 20.12.2017

Gülşah Şahin Mustafa Reşat Dabak , Gülbüz Sezgin Can Dolapçıoğlu Emel Ahıskalı Oya Uygur Bayramiçli

https://doi.org/10.17098/amj.364159

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

Öz

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. 

Anahtar Kelimeler

Manometry, type 2 diabetes mellitus, diabetic autonomic neuropathy

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