Assessment of Cardiac Autonomic Neuropathy and Associated Factors Among Type 2 Diabetes Mellitus Patients at Arsi University Referral and Teaching Hospital, Southeast Ethiopia; A Cross-Sectional Study

Abstract

Background: Cardiovascular Autonomic Neuropathy is one of the most underdiagnosed complication of diabetes mellitus. It is the impairment of autonomic control of cardiovascular system. Due to a significant risk of cardiac arrhythmias, silent myocardial ischemia, and sudden death, patients with CAN have a five-fold increased mortality risk. Currently, there is no published data in Ethiopia on the prevalence of cardiac autonomic neuropathy and associated factors amongst type 2 diabetic patients. Objective: The present study aimed to assess cardiac autonomic neuropathy and associated factors among Type 2 diabetes mellitus patients at Arsi University Referral and Teaching Hospital, Asella, Ethiopia 2021. Methods: Hospital-based cross-sectional study design was conducted among Type 2 diabetes mellitus patients who were under follow-up care in Arsi University Referral and Teaching Hospital. Systematic random sampling technique was used and data were collected by using semi constructed questionnaire, reviewing patient cards, measuring anthropometry and vital sign of patients. Cardiovascular Autonomic Neuropathy was assessed using the five autonomic function tests: resting heart rate, heart rate response to deep breathing, heart response to standing from supine, change in systolic blood pressure during standing, and in diastolic blood pressure during sustained handgrip. The data were entered into Epi data version 4.6.0.2 and transported to SPSS version- 26 software for further analysis. Multi-variant logistic regression was used to identify independent predictors of Cardiovascular Autonomic Neuropathy; P < 0.05 was considered statistically significant. Results: Among 260 subjects, 131 were suffering from CAN giving an overall prevalence of CAN 50.4% 95% CI (44.6-56.2). From all the CAN patients, 68 (26.2%) CI (21.2-31.5) had moderate CAN (Ewing score 2) while 63(24.2%) CI (18.8-29.2) had severe CAN (Ewing scores >2). Older age [AOR = 4.106, 95% CI: (2.182 - 7.725), P<0.01], longer duration of diabetes [AOR = 2.324, 95% CI: (1.281 - 4.216), P < 0.05], P < 0.05], poor glycemic control [AOR = 2.287, 95% CI: (1.146 - 4.562) ), P < 0.05], presence of hypertension [AOR = 1.980, 95% CI (1.108 - 3.540) ),and retinopathy [AOR = 2.024, 95% CI (1.15 2- 3.556), P < 0.05] were significant risk factors for CAN in T2DM patients. Conclusion and Recommendation: . CAN accounts more than half of T2DM and associated with Older age, being hypertensive, longer duration of diabetes, poor glycemic control, and having retinopathy which may indicate that Clinicians in the DM OPD should be aware of the high prevalence of CAN and Consider CAN screening in all diabetes patients during their regular follow-up.