Cardiovascular autonomic neuropathy is the most frequent clinical form of autonomous diabetic neuropathy and appears secondary to cardiac autonomous fibre involvement, actively involved in cardiac rhythm impairment. Type 2 diabetes mellitus patients can present cardiac autonomic neuropathy early in the disease. Autonomous nerve function in DM patients should be assessed as early as the diagnosis is set in order to establish the optimal therapeutic strategy. The most frequent cardio-vagal test used is heart rate variability. An abnormal heart rate variability in the presence of orthostatic arterial hypotension indicates a severe cardiac autonomic neuropathy diagnosis. The development of cardiac autonomic neuropathy is subjected to glycaemic control, duration of the disease and associated risk factors. The glycaemic control is extremely important, especially early in the disease. Therefore, a poor glycaemic control carries unfavourable long-term effects, despite an ulterior optimal control, a phenomenon named “hyperglycaemic memory”. In type 2 diabetes mellitus patients, the association of cardiac autonomic neuropathy with intensive glycaemic control increases the mortality rate, due to the fact, that, secondary to autonomous impairment, the patients do not present the typical symptoms associated with hypoglycaemia. Stratifying the cardiac autonomic neuropathy aids the clinician in assessing the morbidity and mortality risk of diabetes mellitus patients, because it is an independent risk factor for mortality, associated with silent myocardial infarctions and the risk of sudden death.
Our objective was to investigate immunological changes that occur in saliva of subjects with type 2 diabetes mellitus (T2DM) without signs of periodontal disease and to establish if salivary inflammatory cytokines are a possible link between diabetes mellitus and periodontal breakdown. Material and methods. Twenty T2DM subjects with no periodontal disease and twenty healthy controls were registered for the present study. TNF-α and IL-6 level from saliva and serum were measured. Periodontal tissue samples were histologically examined.
Results: TNF-α and IL-6 levels were higher in T2DM subjects compared to controls, with an extremely significant difference in saliva (p<0.001). Significant inflammation, affecting both epithelial and connective tissues was present in periodontal biopsies. Conclusions: The subjects showed an increased TNF-α and IL-6 levels, both in serum and -mostly in -saliva of diabetics without signs of periodontal disease, confirming the hypothesis of immunological implication, as a correlation between periodontal disease incidence and diabetes mellitus. Histologic alterations, suggesting a local inflammatory state, were present in periodontal tissue of diabetics, confirming the above hypothesis. The study reveals that saliva analysis is a quite efficient method in testing the periodontal breakdown progression in the subjects with T2DM.
Introduction: In the last few years many studies were focused on the implications of Helicobacter pylori infection in the evolution of patients with diabetes mellitus. Most of the results are controversial. Our aim was to study the prevalence of the bacterial infection and some of its epidemiological features in diabetic versus non-diabetic patients and the particularities of the association of Helicobacter pylori with diabetes mellitus.
Material and method: We studied 70 consecutive patients with dyspeptic syndrome evaluated with The Leeds Dyspepsia Questionnaire, divided in 2 groups: 35 diabetic and 35 non-diabetic patients.
Results: The prevalence of the Helicobacter pylori infection was similar in our groups (p >0.05). Inside each group, the prevalence of bacterial infection did not differ related to the determination method – serology vs. invasive test (p >0.05). In the diabetic patients we found a positive correlation between the bacterial infection and parameters like family size (>5) (p <0.01). The metabolic control of the diabetics was not influenced by the infection. Regarding diabetes complications, there is significant association of neuropathy with Helicobacter pylori. The eradication rate of infection was similar in diabetic and non-diabetic groups.
Conclusions: The prevalence of Helicobacter pylori infection did not differ in diabetics versus non-diabetics. Both determination me-thods proved similar efficacy for bacterial diagnosis, but is recommended an association of an indirect and a direct method. The bacteria did not influence the glycemic status. Neuropathy is strongly associated with Helicobacter pylori infection.
Background: The neuropathic complications related to diabetes may affect the somatic, sympathetic and parasympathetic nervous system, causing diabetic neuropathy. The aim of this prospective study was to investigate cardiovascular autonomic dysfunction and to determine the relationships between diabetic cardiovascular autonomic neuropathy (CAN), autonomic symptoms and diabetic sensorimotor polyneuropathy (DPN).
Methods: The prevalence of CAN among 57 patients with type 2 diabetes mellitus (DM) was assessed by the five autonomic function tests by Ewing’s methodology. DPN was diagnosed on the basis of both clinical criteria and electrodiagnostic studies in upper and lower limbs.
Results: Patients with CAN had a longer duration of diabetes (p<0.0001), a poorer glycemic control (p=0.02), and a higher prevalence of DPN (p<0.0001). There were no significant differences in sex distribution, body mass index, lipid profile and blood pressure between patients with and without CAN.
Conclusion: Our results confirmed the associations of CAN with duration of diabetes and poorer glycemic control. The natural progression of CAN is insidious and the symptoms are miscellaneous and manifesting at a relatively late stage. With the aim of preventing CAN, diabetic patients should receive a precocious diagnosis and be instructed for having a good metabolic control.