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A study of cardiovascular autonomic function tests in alcoholic patients with Type-2 diabetes mellitus attending North Bengal Medical College and Hospital

Swarup Kumar Khan, Krishna Chandra Sarkar, Kaushik Samajder, Anil Chaudhary.

Abstract
Background: Diabetes mellitus (DM), a growing and alarming disease of today’s India, causes a great deal of micro- and macro-vascular complications. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN). Alcohol adds more to the problem and causes alteration to the hemodynamics. Recently, it has also been shown that patients with alcoholic dependence frequently suffer from autonomic neuropathy. In the rising trend of alcoholism today in respect to stress and social status maintenance, people including diabetics are silently slipping toward this grave disease of CAN. In this context, we have tried to evaluate the cardiovascular autonomic functions and their correlations, if any, among the people of alcoholic and non-alcoholic Type-2 DM (T2DM).

Aims and Objectives: The present study was conducted to assess the cardiovascular autonomic functions to find out the amalgamated effect of alcohol with T2DM.

Materials and Methods: The study was conducted in the Department of Physiology in North Bengal Medical College and Hospital based on non-invasive techniques to determine the cardiovascular autonomic functions in the alcoholic and non-alcoholic type-2 diabetic mellitus individuals. Our study was focused mainly on the heart rate (HR) and blood pressure (BP) variation for diagnosing CAN although other parameters have also been taken into consideration. The simple, reliable, and quantitative autonomic function tests such as the deep breathing test, postural tachycardia index, Valsalva maneuver, Cold Pressor Test, handgrip, and head tilt tests were done among a group of Type-2 diabetic alcoholic and non-alcoholic patients of more than 3 years duration, comprising 73 males and 27 females in the age group of 40–70 years. Taking permission from the Institutional Ethical Committee and after thorough examination of the patients, autonomic function tests were carried out and the collected data have been analyzed statistically.

Results: It has been seen after tests that 98% of the subjects are suffering from cardiac autonomic neuropathy (variable HR and BP) indicating that diabetes alone can lead to autonomic nervous system (ANS) dysfunction even to a smaller degree after few years of onset of the disease. The degree of affection showed an increasing trend in the alcoholic diabetic subjects than the nonalcoholic diabetic subjects in tests such as supine to standing, Valsalva maneuver, deep breathing test, and cold pressure test as P-values were significantly different in those tests (P < 0.05). There was a non-significant difference in change of BP in tilt table test and handgrip test between the alcoholic and non-alcoholic diabetic groups where P > 0.05 was detected.

Conclusion: The ANS plays a pivotal role in cardiovascular homeostasis. HR variability is considered the earliest indicator and most frequent finding in symptomatic cardiovascular autonomic dysfunction. The uniqueness of this study is that it included the combined diabetic alcoholic group for which very few studies have been conducted.

Key words: Diabetes Mellitus; Chronic Alcohol Abuses; Micro- and Macro-vascular Angiopathy; Autonomic Neuropathy; Coronary Artery Disease; Cerebrovascular Events



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