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Pittsburgh Epidemiology of Diabetes Complications Study III

Raelene E. Maser, PhD; Michael A. Pfeifer, MD; Janice S. Dorman, PhD; Lewis H. Kuller, MD; Dorothy J. Becker, MBBCh; Trevor J. Orchard, MBBCh

Arch Intern Med. 1990;150(6):1218-1222.

Abstract
• Diabetic autonomic neuropathy (DAN) has been shown to confer a high risk of mortality. The association between DAN and cardiovascular risk factors was examined in a well-defined cohort of 25- to 34-year-old insulin-dependent diabetes mellitus subjects (n 168) with and without DAN as evaluated by heart rate response to deep breathing, standing, and the Valsalva maneuver. The autonomic tests were performed using both an office-based procedure and a method employed by the Diabetes Control and Complications Trial with analyses performed by the Diabetes Research and Analysis Association, Lexington, Ky. Good agreement was found between the procedures for the assessment modalities of heart rate response to deep breathing. Modeling potential correlates in logistic analyses, where heart rate response to deep breathing was the dependent variable, revealed hypertension status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and gender (female) to be independent determinants of DAN. These results suggest that traditional cardiovascular risk factors are important correlates of DAN and may relate to both its cause and poor prognosis. Since these results are from a cross-sectional study, prospective follow-up of this cohort will be needed for confirmation.

(Arch Intern Med. 1990;150:1218-1222)

Author Affiliations
From the Department of Epidemiology, University of Pittsburgh (Pa) (Drs Maser, Dorman, Kuller, and Orchard); Humana Hospital-Lexington, Diabetes Center of Excellence, Lexington, Ky (Dr Pfeifer); and Department of Endocrinology, Children's Hospital of Pittsburgh (Pa) (Dr Becker). Dr Maser is now with the University of Delaware, Newark.

Footnotes
Accepted for publication February 12,1990.

Reprint requests to the Diabetes Research Center, Suite 502, 3600 Forbes Ave, Pittsburgh, PA 15213 (Dr Orchard).

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