PROSPECTIVE-STUDY OF AUTONOMIC NERVE FUNCTION IN TYPE-1 AND TYPE-2 DIABETIC-PATIENTS - 24-HOUR HEART-RATE VARIATION AND PLASMA MOTILIN LEVELS DISTURBED IN PARASYMPATHETIC NEUROPATHY

To clarify the impact of autonomic neuropathy in diabetic patients, we have conducted a prospective study of 58 Type 1 and 51 Type 2 diabeti c patients (investigated at baseline, after 4, and after 7 years). In Type 1 diabetic patients, the sympathetic nerve function (orthostatic acceleration and brake indices) and in Type 2 patients, parasympatheti c nerve function (R-R interval variation; E/I ratio) deteriorated duri ng 7 years of prospective observation. Symptoms of autonomic neuropath y were associated with signs of autonomic neuropathy (low brake indice s) in Type 1 but not in Type 2 diabetic patients. In the latest assess ment 24 h ECG recording was performed and blood samples assayed for ne uropeptide Y (NPY) and motilin were obtained. Type 1 diabetic patients with parasympathetic neuropathy (abnormal E/I ratio) showed significa ntly lower SD value (less variation in the R-R intervals; 29 [17] vs 5 0 [16], [mean {interquartile range}]; p=0.001) and higher postprandial plasma motilin values (70 [20] pmol l(-1) vs 50 [15] pmol l(-1); p<0. 01) than patients with normal parasympathetic nerve function. In Type 2 diabetic patients, sympathetic neuropathy (low brake indices) was as sociated with an increased frequency of ventricular extra systolic bea ts during 24 h ECG recording (r(s)=0.65; p<0.01). Postprandial plasma NPY levels were not associated with disturbed autonomic nerve function .