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Original Article

Therapeutic Review of Metformin and Sulfonylureas Regimen for Protection of Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus

Volume 2, Oct 2013

Pradeep Dwivedi, MD (Pharmacology), Bajrang Prasad Lal Pandey, MD (Pharmacology), Surya Kumar Singh, MD (Medicine), Suraj Singh Yadav, MSc (Biotechnology), Sanjay Khattri, MD (Pharmacology), Lucknow, India

Background: Cardiovascular autonomic neuropathy (CAN) is an important progressive complication of type 2 diabetes mellitus (T2DM). Therapeutic salvation of CAN is usually not practiced either due to lack of awareness or no consensus treatment is available for its management.
Methods: A prospective, observational, open label, non-randomized cohort study enrolling 63 patients of T2DM, examined thrice clinically and for CAN in 6 months followup. The CAN score in each patients and its relation to metformin plus sulfonylureas regimen over 6 months was analyzed. Possible influences of age, obesity (BMI), duration of diabetes, glycosylated hemoglobin (HbA1c) level and coexistent peripheral neuropathy on occurrence of CAN were also studied.

Results: The prevalence of CAN was as high as 62% in our (North Indian) patients. Univariate analysis showed a significant association between CAN and higher age (p<0.002), obesity (BMI) (p<0.001), HbA1c (p<0.0001), duration of diabetes (p<0.001), hypertension (p<0.004), peripheral neuropathy (p<0.001) and erectile dysfunction (p<0.001), but only obesity (BMI), HbA1c, duration of diabetes, peripheral neuropathy and erectile dysfunction showed independent risk on multivariate analysis. Metformin plus sulfonylureas regimen targeting normal level of HbA1c (<7) resulted in improvement of CAN. Although various factors affect outcome of CAN independently such as obesity (BMI), duration of diabetes and HbA1c, we got 40% improvement in CAN in patients with dysglycemia (HbA1c >10) with combination regimen.

Conclusions: The prevalence of CAN in T2DM is fairly high (62%) in North Indian population. Higher HbA1c, longer diabetes duration and obesity (BMI) are significant risk factors. Although there is improvement in glycemic level of patients receiving metformin plus sulfonylureas therapy, but overall improvement of CAN needs more elucidation of pathogenesis of diabetic autonomic neuropathy and new insights and agents of therapy. (J Clin Prev Cardiol. 2013;2(4):178-84)

Keywords: cardiac autonomic neuropathy (CAN); type 2 diabetes mellitus (T2DM); glycosylated hemoglobin (HbA1c); body mass index (BMI

Volume 2, Number 4, Pages: 178-84

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