Neuropatia vegetativa em pacientes com tolerância diminuída à glicose

Rezende, Karla Freire; Melo, Ailton; Pousada, Judith; Rezende, Zulmira Freire; Santos, Norma Lúcia; Gomes, Irenio

doi:10.1590/S0004-282X1997000500005

Resumos

Com o objetivo de determinar se tolerância diminuída à glicose (TDG) está associada a neuropatia vegetativa realizamos estudo transversal de que participaram 44 pacientes com intolerância a glicose (Grupo 1) os quais foram comparados com 43 indivíduos controles apresentando teste de tolerância à glicose normal (Grupo 2). Os pacientes de ambos os grupos, após aceitarem participar da pesquisa, eram submetidos a anamnese, exames clínico e laboratoriais e estudo da função vegetativa (intervalo QT, prova da arritmia sinusal, manobra de Valsalva e teste postural). Os pacientes com TDG apresentaram mais hipertensão arterial sistêmica, obesidade centrípeta, hiperglicemas de jejum e pós-prandiais e dislipidemias que os controles. O teste de arritmia sinusal estava alterado em 54,5% dos grupo 1 e em 32,5% do grupo 2. A manobra de Valsalva foi anormal em 34,1% no grupo 1 e em 7% dos controles (p=0,004). A prova postural não foi diferente nos dois grupos. O comprometimento do sistema neurovegetativo foi mais freqüente nos pacientes com TDG que nos controles. A maior freqüência de fatores de risco para doença aterosclerótica cardiovascular e o concomitante comprometimento do sistema nervoso vegetativo nos pacientes com TDG podem ser os responsáveis pelas elevadas taxas de letalidade devida a vasculopatias observadas nessa população.

diabetes mellitus; neuropatia vegetativa; intolerância a glicose; neuropatia periférica

Impaired glucose tolerance (1GT) is a clinical situation characterized by mild hyperglicemia, which is estimated to afflict 7.8% of the Brazilian population. Diabetic neuropathy is the most common: complication in diabetes mellitus and it is related to morbidity and lethality in this disease. The associatior between IGT and peripheral neuropathy is still a matter of great concern. PURPOSE AND METHOD: In order to determine if IGT is associated with autonomic neuropathy a cross-sectional study in 44 patients with impaired glucose tolerance test (Group 1) was performed. The patients were compared to 43 control individuals (Group 2). Every patient in each group underwent anamnesis and standardized autonomic tests which consisted of hear) frequency test, Valsalva maneuver, postural test and sinus arrythmia. Routine hematologic exams as well as GTT were also made. RESULTS: Patients in group 1 had more systemic arterial hypertension, centripetal obesity, fasting and post-feeding hyperglicemia and dyslipidemia when compared with group 2. When we analysed the autonomic tests, the sinus arrythmia test was abnormal in 54.5% of the patients in group 1 and in 32.5% in group 2 (p=0.0039) and the Valsalva maneuver was abnormal in 34.1% of group 1 and in 7% of group 2 (p=0.004). The postural test was not different in both groups (p=0.334). CONCLUSION: Our results show that the involvement of the autonomic nervous system was more frequent in patients with IGT when compared to controls. These findings can explair the increased lethality due to vasculopathies observed in this group of patients and also alert physicians to care for patients with impaired glucose tolerance test.

diabetes mellitus; impaired tolerance glucose; autonomic disorders; peripheral neuropathy

Neuropatia vegetativa em pacientes com tolerância diminuída à glicose

Autonomic neuropathy in patients with impaired glucose tolerance test

Karla Freire Rezende^I; Ailton Melo^II; Judith Pousada^II; Zulmira Freire Rezende^I; Norma Lúcia Santos^I; Irenio Gomes^II

^IServiço de Endocrinologia da Universidade Federal de Sergipe (UFSE)

^IIDivisão de Neuroepidemiologia / Neuroinfectologia da Universidade Federal da Bahia (UFBA)

RESUMO

Com o objetivo de determinar se tolerância diminuída à glicose (TDG) está associada a neuropatia vegetativa realizamos estudo transversal de que participaram 44 pacientes com intolerância a glicose (Grupo 1) os quais foram comparados com 43 indivíduos controles apresentando teste de tolerância à glicose normal (Grupo 2). Os pacientes de ambos os grupos, após aceitarem participar da pesquisa, eram submetidos a anamnese, exames clínico e laboratoriais e estudo da função vegetativa (intervalo QT, prova da arritmia sinusal, manobra de Valsalva e teste postural). Os pacientes com TDG apresentaram mais hipertensão arterial sistêmica, obesidade centrípeta, hiperglicemas de jejum e pós-prandiais e dislipidemias que os controles. O teste de arritmia sinusal estava alterado em 54,5% dos grupo 1 e em 32,5% do grupo 2. A manobra de Valsalva foi anormal em 34,1% no grupo 1 e em 7% dos controles (p=0,004). A prova postural não foi diferente nos dois grupos. O comprometimento do sistema neurovegetativo foi mais freqüente nos pacientes com TDG que nos controles. A maior freqüência de fatores de risco para doença aterosclerótica cardiovascular e o concomitante comprometimento do sistema nervoso vegetativo nos pacientes com TDG podem ser os responsáveis pelas elevadas taxas de letalidade devida a vasculopatias observadas nessa população.

Palavras-chaves: diabetes mellitus, neuropatia vegetativa, intolerância a glicose, neuropatia periférica.

ABSTRACT

Impaired glucose tolerance (1GT) is a clinical situation characterized by mild hyperglicemia, which is estimated to afflict 7.8% of the Brazilian population. Diabetic neuropathy is the most common: complication in diabetes mellitus and it is related to morbidity and lethality in this disease. The associatior between IGT and peripheral neuropathy is still a matter of great concern.

PURPOSE AND METHOD: In order to determine if IGT is associated with autonomic neuropathy a cross-sectional study in 44 patients with impaired glucose tolerance test (Group 1) was performed. The patients were compared to 43 control individuals (Group 2). Every patient in each group underwent anamnesis and standardized autonomic tests which consisted of hear) frequency test, Valsalva maneuver, postural test and sinus arrythmia. Routine hematologic exams as well as GTT were also made.

RESULTS: Patients in group 1 had more systemic arterial hypertension, centripetal obesity, fasting and post-feeding hyperglicemia and dyslipidemia when compared with group 2. When we analysed the autonomic tests, the sinus arrythmia test was abnormal in 54.5% of the patients in group 1 and in 32.5% in group 2 (p=0.0039) and the Valsalva maneuver was abnormal in 34.1% of group 1 and in 7% of group 2 (p=0.004). The postural test was not different in both groups (p=0.334).

CONCLUSION: Our results show that the involvement of the autonomic nervous system was more frequent in patients with IGT when compared to controls. These findings can explair the increased lethality due to vasculopathies observed in this group of patients and also alert physicians to care for patients with impaired glucose tolerance test.

Key words: diabetes mellitus, impaired tolerance glucose, autonomic disorders, peripheral neuropathy

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 6-agosto-1997.

Dr. Ailton Melo - Av. Magalhães Neto 735/802 - 41820-144 Salvador BA - Brasil.

1. Ashwell M. Obesity in men and women. Internat J Obesity 1994;18(Suppl 1):sl-s7.
2. Bergstrom B, Lilja B, Österlin S, Sundkvist G. Autonomic neuropathy in non-insulin dependent (type II) diabetes mellitus: posible influence of obesity. J Internal Med 1990;227:57-63.
3. Boden G. Fatty acids and insulin resistence. Diabetes Care 1996;19:394-395.
4. Bourn MD, Mann LI, McSkimming JB, Waldron AM, Wishart DJ. Impaired glucose tolerance and NIDDM: does a lifestyle intervention program have an effect? Diabetes Care 1994;17:1311-1319.
5. Capaldo B, Tutino L, Patti L, Vaccaro O, Rivellese A, Riccardi G. Lipoprotein composition in individuals with imparied glucose tolerance. Diabetes Care 1983;6:575-578.
6. Cederholm J, Fagius J, Wibell L. Peripheral and autonomic nerve function in glucose intolerance. Diabetes & Metabolism 1985;11:87-91.
7. Curb JD, Rodriguez BL, Burchfiel CM, Abbott RD, Chiu D, Yano K. Sudden death, imparted glucose tolerance, and diabetes in Japanese american men. Circulation 1995;91:2591-2595.
8. Dyck JP. Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle & Nerve 1988;21:21-32.
9. Eriksson KF, Nilsson H, Lindgarde F, Osterlin S, Dahlin LB, Lilja B, Rosén I, Sundkvist G. Diabetes mellitus but not imparied glucose tolerance is associated with dysfunction in peripheral nerves. Diabetic Med 1994;11:279-285.
10. Ewing DJ, Campbell IW, Clarke BF. Heart rate changes in diabetes mellitus. Lancet 1981;24:183-185.
11. Fujiwara R, Kutsumi Y, Hayashi T, Nishio H, Koshino Y, Shimada Y, Nakai T, Miyabo S. Relation of angiographically difined coronary artery disease and plasma concentration of insulin, lipid, and apolipoprotein in normolipidemic subjects with varying degrees of glucose tolerance. Am J Cardiol 1995;75:122-126.
12. Groop LC, Sarolanta C, Shank M, Bonadonna RC, Ferrannini E, DeFronzo RA. The role of free fatty acid metabolism in the pathogenesis of insulin resistence in obesity and noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1991;72:96-107.
13. Hartwig MS, Cardoso SS, Hathaway DK, Gaber AO. Reliability and validity of cardiovascular and vasomotor autonomic function tests. Diabetes Care 1994,17:1433-1440.
14. Instituto Brasileiro de Geografia e Estatística. Censo populacional do Brasil: dados demográficos. Rio de Janeiro, 1991:1-209.
15. Jadzinsky MN. El espectro clínico de la neuropatia diabética. In Rull JA, Zorrilla E, Jadzinsk MN, Santiago JV (eds). Diabetes melitus: complicaciones crônicas. México: Nueva Editorial Interamericana, 1992.
16. Kannel BW, Abbot R. Incidence and prognosis of unrecognized myocardial infarction (an update on the Framingharr study). N Engl J Med 1984;311:1144-1147.
17. Larsson B, Svãrdsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribuition, obesity, and risk of cardiovascular disease and death: 13 year follow up participants in the study of men bom in 1913. Br Med J 1984;288:1401-1404.
18. Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and imparied glucose tolerance in urban Brazilian population aged 30-69 yr. Diabetes Care 1992;15:1509-1516.
19. Must A, Jacques PF, Dallal GE, Bajema C J, Dietz WH. Long-term morbidity and mortality of overweight adolescents. N Engl J Med 1992;327:1350-1355.
20. Ohlson OL, Larsson B, Svärdsudd K, Welin L, Eriksson H, Wilhelmsen L, Bjärntorp P, Tibblin G. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1995;34:1055-1058.
21. Parriello G, Misericordia P, Volpi E, Pampaneli S, Santeusanio F, Brunetti P, Bolli BG. Contribution of obesity to insulin resistance in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1995;80:2464-2469.
22. Pfeifer MA, Peterson H. Cardiovascular autonomic neuropathy. In Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D Jr. (eds). Diabetic neuropathy. Philadelphia: W.B. Saunders, 1987:12.
23. Reaven GM. Role of insulin resistence in human disease. Diabetes 1988;37:1596-1607.
24. Reaven GM, Chen I, Jeppesen J, Maheux P, Krauss RM. Insulin resistence and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles. J Clin Invest 1993;92:141-146.
25. Stewart WM, Humphriss BD, Berrish ST, Barriocanal AL, Trajano RL, Albert MMGK, Walker M. Features of syndrome x in first-degree relatives of NIDDM patients. Diabetes Care 1995;18:1020-1022.
26. Stolk RP, Orchard TJ, Grobbee DE. Why use the oral glucose tolerante test? Diabetes Care 1995;18:1045-1049.
27. Vinik AI, Holland MT, Le Beau JM, Luizzi FJ, Stansberry KB, Colen LB. Diabetic neuropathies. Diabetes Care 1992;15:1926-1975.
28. West KM, Ahuja MMS, Bennet PH, Czyzyk A, Mateo de Acosta O, Fuller JH, Grab B, Grabauskas V, Jarrett J, Kosaka K, Keen H, Krolewski AS, Miki E, Schliack V, Teuscher A, Watkins PJ, Stober JA. The role of circulating glucose and triglyceride concentrations and their interactions with other "risk factors" as determinants of arterial disease in nine diabetic population samples from the WHO multinational study. Diabetes Care 1983;6:361-369.
29. Wheeler T., Watkins J.P. Cardiac denervation in diabetes. Br Med J 1973;4:584-586.
³⁰
World Health Organization. WHO Expert Committee on Diabetes Mellitus: third report (Technical Report Series N° 727). Geneva: WHO, 1985.

Datas de Publicação

Publicação nesta coleção
07 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ashwell M. Obesity in men and women. Internat J Obesity 1994;18(Suppl 1):sl-s7.

[2] 2. Bergstrom B, Lilja B, Österlin S, Sundkvist G. Autonomic neuropathy in non-insulin dependent (type II) diabetes mellitus: posible influence of obesity. J Internal Med 1990;227:57-63.

[3] 3. Boden G. Fatty acids and insulin resistence. Diabetes Care 1996;19:394-395.

[4] 4. Bourn MD, Mann LI, McSkimming JB, Waldron AM, Wishart DJ. Impaired glucose tolerance and NIDDM: does a lifestyle intervention program have an effect? Diabetes Care 1994;17:1311-1319.

[5] 5. Capaldo B, Tutino L, Patti L, Vaccaro O, Rivellese A, Riccardi G. Lipoprotein composition in individuals with imparied glucose tolerance. Diabetes Care 1983;6:575-578.

[6] 6. Cederholm J, Fagius J, Wibell L. Peripheral and autonomic nerve function in glucose intolerance. Diabetes & Metabolism 1985;11:87-91.

[7] 7. Curb JD, Rodriguez BL, Burchfiel CM, Abbott RD, Chiu D, Yano K. Sudden death, imparted glucose tolerance, and diabetes in Japanese american men. Circulation 1995;91:2591-2595.

[8] 8. Dyck JP. Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle & Nerve 1988;21:21-32.

[9] 9. Eriksson KF, Nilsson H, Lindgarde F, Osterlin S, Dahlin LB, Lilja B, Rosén I, Sundkvist G. Diabetes mellitus but not imparied glucose tolerance is associated with dysfunction in peripheral nerves. Diabetic Med 1994;11:279-285.

[10] 10. Ewing DJ, Campbell IW, Clarke BF. Heart rate changes in diabetes mellitus. Lancet 1981;24:183-185.

[11] 11. Fujiwara R, Kutsumi Y, Hayashi T, Nishio H, Koshino Y, Shimada Y, Nakai T, Miyabo S. Relation of angiographically difined coronary artery disease and plasma concentration of insulin, lipid, and apolipoprotein in normolipidemic subjects with varying degrees of glucose tolerance. Am J Cardiol 1995;75:122-126.

[12] 12. Groop LC, Sarolanta C, Shank M, Bonadonna RC, Ferrannini E, DeFronzo RA. The role of free fatty acid metabolism in the pathogenesis of insulin resistence in obesity and noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1991;72:96-107.

[13] 13. Hartwig MS, Cardoso SS, Hathaway DK, Gaber AO. Reliability and validity of cardiovascular and vasomotor autonomic function tests. Diabetes Care 1994,17:1433-1440.

[14] 14. Instituto Brasileiro de Geografia e Estatística. Censo populacional do Brasil: dados demográficos. Rio de Janeiro, 1991:1-209.

[15] 15. Jadzinsky MN. El espectro clínico de la neuropatia diabética. In Rull JA, Zorrilla E, Jadzinsk MN, Santiago JV (eds). Diabetes melitus: complicaciones crônicas. México: Nueva Editorial Interamericana, 1992.

[16] 16. Kannel BW, Abbot R. Incidence and prognosis of unrecognized myocardial infarction (an update on the Framingharr study). N Engl J Med 1984;311:1144-1147.

[17] 17. Larsson B, Svãrdsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribuition, obesity, and risk of cardiovascular disease and death: 13 year follow up participants in the study of men bom in 1913. Br Med J 1984;288:1401-1404.

[18] 18. Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and imparied glucose tolerance in urban Brazilian population aged 30-69 yr. Diabetes Care 1992;15:1509-1516.

[19] 19. Must A, Jacques PF, Dallal GE, Bajema C J, Dietz WH. Long-term morbidity and mortality of overweight adolescents. N Engl J Med 1992;327:1350-1355.

[20] 20. Ohlson OL, Larsson B, Svärdsudd K, Welin L, Eriksson H, Wilhelmsen L, Bjärntorp P, Tibblin G. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1995;34:1055-1058.

[21] 21. Parriello G, Misericordia P, Volpi E, Pampaneli S, Santeusanio F, Brunetti P, Bolli BG. Contribution of obesity to insulin resistance in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1995;80:2464-2469.

[22] 22. Pfeifer MA, Peterson H. Cardiovascular autonomic neuropathy. In Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D Jr. (eds). Diabetic neuropathy. Philadelphia: W.B. Saunders, 1987:12.

[23] 23. Reaven GM. Role of insulin resistence in human disease. Diabetes 1988;37:1596-1607.

[24] 24. Reaven GM, Chen I, Jeppesen J, Maheux P, Krauss RM. Insulin resistence and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles. J Clin Invest 1993;92:141-146.

[25] 25. Stewart WM, Humphriss BD, Berrish ST, Barriocanal AL, Trajano RL, Albert MMGK, Walker M. Features of syndrome x in first-degree relatives of NIDDM patients. Diabetes Care 1995;18:1020-1022.

[26] 26. Stolk RP, Orchard TJ, Grobbee DE. Why use the oral glucose tolerante test? Diabetes Care 1995;18:1045-1049.

[27] 27. Vinik AI, Holland MT, Le Beau JM, Luizzi FJ, Stansberry KB, Colen LB. Diabetic neuropathies. Diabetes Care 1992;15:1926-1975.

[28] 28. West KM, Ahuja MMS, Bennet PH, Czyzyk A, Mateo de Acosta O, Fuller JH, Grab B, Grabauskas V, Jarrett J, Kosaka K, Keen H, Krolewski AS, Miki E, Schliack V, Teuscher A, Watkins PJ, Stober JA. The role of circulating glucose and triglyceride concentrations and their interactions with other "risk factors" as determinants of arterial disease in nine diabetic population samples from the WHO multinational study. Diabetes Care 1983;6:361-369.

[29] 29. Wheeler T., Watkins J.P. Cardiac denervation in diabetes. Br Med J 1973;4:584-586.

[30] ³⁰
World Health Organization. WHO Expert Committee on Diabetes Mellitus: third report (Technical Report Series N° 727). Geneva: WHO, 1985.