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Open Access 06-11-2024 | Type 1 Diabetes | Original Article

Prevalence of self-reported symptoms of diabetic autonomic dysfunction in the North Denmark Region: a population-based survey

Authors: Maria Bitsch Poulsen, Anne-Marie Wegeberg, Johan Røikjer, Amar Nikontovic, Peter Vestergaard, Christina Brock

Abstract

Aims

Diabetic autonomic neuropathy is a severe complication of diabetes, estimated to affect up to 44% in type 1 diabetes (T1D) and 73% in type 2 diabetes (T2D) based on clinical studies. Currently, the assessment of diabetic autonomic neuropathy is not implemented in Denmark’s clinical guidelines, complicating the estimation of the true prevalence. Thus, this study investigated the prevalence of self-reported symptoms of autonomic dysfunction in people living with diabetes in the North Denmark Region using the Composite Autonomic Symptoms Score (COMPASS)-31 questionnaire.

Methods

In 2022, all adults with T1D or T2D in the North Denmark Region (n = 29,155) were identified using The National Health Insurance Service Registry and invited to an online survey including the Danish version of COMPASS-31. The prevalence and associated 95% confidence intervals (CI) for symptomatic autonomic dysfunction were determined using a cut-off value of 16.

Results

In total, 7,377 completed COMPASS-31, of which 82.4% reported having T2D and 13.7% T1D. The prevalence of symptomatic autonomic dysfunction was 36.8% (95% CI: 34–40) after a median of 26 years with diabetes for T1D and 44.2% (95% CI: 43–45) after a median of 10 years for T2D. Pupillary and orthostatic intolerance were the most frequent moderate to severe symptoms, respectively (38.4% and 24.0% in T1D and 32.8% and 26.3% in T2D).

Conclusion

Symptoms of autonomic dysfunction are very common in individuals with diabetes living in the North Denmark Region, emphasizing the unmet need for regular testing to increase awareness and allow for adequate management, ultimately reducing the morbidity of diabetes.

Freeman R (2014) Diabetic autonomic neuropathy. Handb Clin Neurol 126:63–79. https://doi.org/10.1016/B978-0-444-53480-4.00006-0CrossRefPubMed

Røikjer J, Santhiapillai Croosu S, Maria Hansen T et al (2062) The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain neuropathy. Acta Diabetol 60:777–785. https://doi.org/10.1007/s00592-023-02062-7CrossRef

Vinik AI, Maser RE, Mitchell BD et al (2003) Diabetic Autonomic Neuropathy. Diabetes Care 26:1553–1579. https://doi.org/10.2337/DIACARE.26.5.1553CrossRefPubMed

Kempler P, Amarenco G, Freeman R et al (2011) Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes Metab Res Rev 27:665–677. https://doi.org/10.1002/dmrr.1223CrossRefPubMed

Boulton AJM, Vinik AI, Arezzo JC et al (2005) Diabetic NeuropathiesA statement by the American Diabetes Association. Diabetes Care 28:956–962. https://doi.org/10.2337/DIACARE.28.4.956CrossRefPubMed

Braffett BH, Gubitosi-Klug RA, Albers JW et al (2020) Risk factors for Diabetic Peripheral Neuropathy and Cardiovascular Autonomic Neuropathy in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and complications (DCCT/EDIC) study. Diabetes 69:1000–1010. https://doi.org/10.2337/DB19-1046CrossRefPubMedPubMedCentral

Kempler P, Tesfaye S, Chaturvedi N et al (2002) Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM complications Study. Diabet Med 19:900–909. https://doi.org/10.1046/J.1464-5491.2002.00821.XCrossRefPubMed

Low PA, Benrud-Larson LM, Sletten DM et al (2004) Autonomic symptoms and Diabetic Neuropathy: a population-based study. Diabetes Care 27:2942–2947. https://doi.org/10.2337/DIACARE.27.12.2942CrossRefPubMed

Dimova R, Tankova T, Guergueltcheva V et al (2017) Risk factors for autonomic and somatic nerve dysfunction in different stages of glucose tolerance. J Diabetes Complications 31:537–543. https://doi.org/10.1016/J.JDIACOMP.2016.11.002CrossRefPubMed

10.

Zoppini G, Cacciatori V, Raimondo D et al (2015) Prevalence of Cardiovascular Autonomic Neuropathy in a cohort of patients with newly diagnosed type 2 diabetes: the Verona newly diagnosed type 2 diabetes study (VNDS). Diabetes Care 38:1487–1493. https://doi.org/10.2337/DC15-0081CrossRefPubMed

11.

Valensi P, Pariès J, Attali JR et al (2003) Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications—the French multicenter study. Metabolism 52:815–820. https://doi.org/10.1016/S0026-0495(03)00095-7CrossRefPubMed

12.

Gæde P, Vedel P, Larsen N et al (2003) Multifactorial intervention and Cardiovascular Disease in patients with type 2 diabetes. N Engl J Med 348:383–393. https://doi.org/10.1056/NEJMOA021778/SUPPL_FILE/NEJM_GAEDE_383SA1.PDFCrossRefPubMed

13.

Dansk Endokrinologisk Selskab (2023) https://endocrinology.dk/nbv/diabetes-melitus/diabetisk-neuropati/. Accessed 13 Dec 2023

14.

Befolkningstal - Danmarks Statistik n.d. https://www.dst.dk/da/Statistik/emner/borgere/befolkning/befolkningstal. Accessed 12 Dec 2023

15.

Harris PA, Taylor R, Minor BL et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inf 95:103208. https://doi.org/10.1016/J.JBI.2019.103208CrossRef

16.

Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf 42:377–381. https://doi.org/10.1016/J.JBI.2008.08.010CrossRef

17.

Brinth L, Pors K, Mehlsn J et al (2021) Translation and linguistic validation of the Composite Autonomic Symptom Score COMPASS 31 in Danish. Dan Med J 69

18.

Sletten DM, Suarez GA, Low PA et al (2012) COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc 87:1196–1201. https://doi.org/10.1016/j.mayocp.2012.10.013CrossRefPubMedPubMedCentral

19.

Greco C, Di Gennaro F, D’Amato C et al (2016) Validation of the Composite Autonomic Symptom score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes. Diabet Med 34:834–838. https://doi.org/10.1111/DME.13310CrossRef

20.

Singh R, Arbaz M, Rai NK et al (2019) Diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) in early detection of autonomic dysfunction in type 2 diabetes mellitus. Diabetes Metab Syndr Obes 12:1735. https://doi.org/10.2147/DMSO.S214085CrossRefPubMedPubMedCentral

21.

D’Amato C, Greco C, Lombardo G et al (2020) The diagnostic usefulness of the combined COMPASS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic polyneuropathy. J Peripher Nerv Syst 25:44–53. https://doi.org/10.1111/JNS.12366CrossRefPubMed

22.

Zhang Z, Ma Y, Fu L et al (2020) Combination of Composite Autonomic Symptom Score 31 and Heart Rate Variability for Diagnosis of Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes. J Diabetes Res.;2020. https://doi.org/10.1155/2020/5316769

23.

Ruška B, Pavičić T, Pavlović I et al (2018) Performance of the COMPASS-31 questionnaire with regard to autonomic nervous system testing results and medication use: a prospective study in a real-life setting. Neurol Sci 39:2079–2084. https://doi.org/10.1007/S10072-018-3542-8CrossRefPubMed

24.

Okdahl T, Bertoli D, Brock B et al (2021) Protocol: study protocol for a multicentre, randomised, parallel group, sham-controlled clinical trial investigating the effect of transcutaneous vagal nerve stimulation on gastrointestinal symptoms in people with diabetes complicated with diabetic autono. BMJ Open 11:38677. https://doi.org/10.1136/BMJOPEN-2020-038677CrossRef

25.

Mizokami-Stout K, Bailey R, Ang L et al (2022) Symptomatic diabetic autonomic neuropathy in type 1 diabetes (T1D): findings from the T1D exchange. J Diabetes Complications 36. https://doi.org/10.1016/j.jdiacomp.2022.108148

26.

Stidsen JV, Nielsen JS, Henriksen JE et al (2017) Protocol for the specialist supervised individualised multifactorial treatment of new clinically diagnosed type 2 diabetes in general practice (IDA): a prospective controlled multicentre open-label intervention study. BMJ Open 7. https://doi.org/10.1136/bmjopen-2017-017493

27.

Meling S, Tjora E, Eichele H et al (2023) The Composite Autonomic Symptom score 31 questionnaire: a sensitive test to detect risk for autonomic neuropathy. J Diabetes Res 2023:4441115. https://doi.org/10.1155/2023/4441115CrossRefPubMedPubMedCentral

28.

Traon AP, Le Fontaine S, Tap G et al (2010) Cardiovascular autonomic neuropathy and other complications in type 1 diabetes. Clin Auton Res 20:153–160. https://doi.org/10.1007/S10286-010-0062-X/FIGURES/2CrossRef

29.

Wheeler SG, Ahroni JH, Boyko EJ (2002) Prospective study of autonomic neuropathy as a predictor of mortality in patients with diabetes. Diabetes Res Clin Pract 58:131–138. https://doi.org/10.1016/S0168-8227(02)00128-6CrossRefPubMed

30.

Young LH, Wackers FJT, Chyun DA et al (2009) Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD Study: a Randomized Controlled Trial. JAMA: J Am Med Association 301:1547. https://doi.org/10.1001/JAMA.2009.476CrossRef

31.

Boerma T, Hosseinpoor AR, Verdes E et al (2016) A global assessment of the gender gap in self-reported health with survey data from 59 countries. BMC Public Health 16:1–9. https://doi.org/10.1186/S12889-016-3352-Y/FIGURES/2CrossRef

32.

Mathisen J, Jensen AKG, Andersen I et al (2020) Education and incident type 2 diabetes: quantifying the impact of differential exposure and susceptibility to being overweight or obese. Diabetologia 63:1764–1774. https://doi.org/10.1007/S00125-020-05150-3CrossRefPubMed

33.

Ullits LR, Ejlskov L, Mortensen RN et al (2015) Socioeconomic inequality and mortality - a regional Danish cohort study. BMC Public Health 15. https://doi.org/10.1186/S12889-015-1813-3

34.

Stronks K, Van De Mheen HD, Mackenbach JP (1998) A higher prevalence of health problems in low income groups: does it reflect relative deprivation? J Epidemiol Community Health (1978) 52:548. https://doi.org/10.1136/JECH.52.9.548CrossRef

35.

Sahl Andersen J, De Fine Olivarius N, Krasnik A (2011) The Danish national health service register. Scand J Public Health 39:34–37. https://doi.org/10.1177/1403494810394718CrossRef

36.

Statistik om Digital Post n.d. https://digst.dk/it-loesninger/digital-post/om-loesningen/tal-og-statistik/. Accessed 14 June 2024

37.

Postnummer afgør risiko for mere sygdom og død n.d. https://diabetes.dk/nyheder/2023/postnummer-afgor-risiko-for-mere-sygdom-og-dod. Accessed 16 Apr 2024

Title: Prevalence of self-reported symptoms of diabetic autonomic dysfunction in the North Denmark Region: a population-based survey
Authors: Maria Bitsch Poulsen
Anne-Marie Wegeberg
Johan Røikjer
Amar Nikontovic
Peter Vestergaard
Christina Brock
Publication date: 06-11-2024
Publisher: Springer Milan
Keywords: Type 1 Diabetes
Type 2 Diabetes
Published in: Acta Diabetologica
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-024-02390-2

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