diabetic neuropathy | Acta Medica Marisiensis

Cardiac Autonomic Neuropathy in Diabetes Mellitus Patients – Are We Aware of the Consequences?

Anca Motataianu¹, Laura Iulia Barcutean², Smaranda Maier¹, Adrian Balasa³, Adina Stoian⁴

1. Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Targu Mures County Clinical Emergency Hospital, Targu Mures, Romania
3 Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0003

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.

Particularities of Helicobacter pylori Infection in Diabetic Patients

Floarea Ramona¹, Georgescu ED², Frunză-Dumitru Anca³, Mitroi-Maxim Corina¹, Maxim RG¹

1 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Internal Medicine Clinic, Bucharest
2 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Department of Internal Medicine, Bucharest
3 ”Carol Davila” University of Medicine and Pharmacy, ”Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Diabetes Clinic, Bucharest

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.