Screening for cardiac autonomic neuropathy: preliminary results from Bosnia and Herzegovina

Introduction: Cardiac autonomic neuropathy (CAN) is important, but often neglected complication of diabetes, that substantially contributes to diabetes-related morbidity and mortality. The majority of diabetic patients have subclinical CAN. Therefore, screening for CAN in patients with diabetes is essential. The aim of this study was to assess the prevalence of subclinical CAN in real-life clinical setting at primary health care institution. We also aimed to determine, which routine clinical and laboratory parameters could serve as predictors of CAN. Methods: We conducted a cross-sectional, prospective, observational study that included 50 consecutive patients with type 2 diabetes treated in the primary health care institution. Gender, age, duration of diabetes, glycated hemoglobin (HbA1c) levels, electrocardiogram, blood pressure, the presence of paresthesia, deep and superficial neuropathy, foot skin lesions and the presence of pulselessness of artery dorsalis pedis and tibialis posterior were recorded. The diagnosis of CAN was made if the patients met two out of three criteria: postural hypotension, increased resting heart rate and corrected QT interval prolongation. Results: Patients had a median age of 59.0 (51.0 – 64.0) years and median duration of diabetes of 9.0 (6.0 – 11.0) years. CAN was present in 19 patients (38%). Patients with CAN had greater duration of diabetes and 2% higher HbA1c. They also had higher prevalence of peripheral neuropathy, foot skin lesions and peripheral artery disease. The presence of peripheral deep neuropathy was the best predictor of CAN with a specificity of 64.5% (45.4 80.8) and sensitivity of 79.0% (54.4 93.9). Conclusion: CAN is a common complication in our cohort of patients with diabetes. Simple routine clinical and laboratory parameters may be useful in detecting patients at high risk for CAN. 1 Public Educationional Healthcare Center Tuzla –Family Medicine Teaching Center 2 Public Healthcare Center GracanicaDepartment of Family Medicine; 3 General Hospital Gracanica; 4 University Clinical Center Tuzla and European University Kallos Tuzla. Azijada Beganlic1, Albina Softic2, Jasmin Alic2, Menedin Causi3, Senada Selmanovic1, Fuad Pasic4, Munevera Becarevic4 Corresponding author: Azijada Beganlic, M.D., PhD, Professor of medicine, Public Educationional Healthcare Center Tuzla, Family Medicine Teaching Center; Albina i Franje Herljevica 1, Tuzla 75000; Bosnia and Herzegovina; Phone number: 00387 63 992 465; E-mail: azijada_beganlic@yahoo.com DOI: 10.21040/eom/2016.2. 3.1 Received: September 1st 2016 Accepted: September 9th 2016 Published: September 15th 2016 Copyright: © Copyright by Association for Endocrine Oncology and Metabolism. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Funding: None. Conflict of interest statement: The authors declare that they have no conflict of interest. Data Availability Statement: All relevant data are within the paper.