To Determine The Prevalence of Cardiac Autonomic Dysfunction in Patients With Type 2 Diabetes Mellitus in A Tertiary Care Centre

Abstract Background: Cardiac autonomic dysfunction (CAD) is a critical yet underdiagnosed complication of diabetes mellitus (DM), linked to increased cardiovascular morbidity and mortality. This cross-sectional study aimed to assess the prevalence, severity, and biochemical correlates of CAD in individuals with DM, emphasizing modifiable risk factors for early intervention. Aim: To determine the prevalence of cardiac autonomic dysfunction in patients with type 2 diabetes mellitus in a tertiary care centre Material and Methods: The study was carried out in the post graduate institute of medicine, GSVM Medical college. The material of study included patients of all age group having diabetes mellitus, conducted for a duration of 18 months. Results: Of the 100 participants (mean age 58.3 ± 9.75 years; 57% male), cardiac autonomic dysfunction was common. Resting heart rate was abnormal in 29%, while deep breathing and standing tests showed dysfunction in 65% and 59%, respectively. Valsalva, postural hypotension, and handgrip tests revealed abnormalities in 12%, 15%, and 80%. Parasympathetic dysfunction was found in 79%, and sympathetic dysfunction in 87% of participants. Overall, 11% had no dysfunction, 25% had mild, 53% moderate, and 11% severe dysfunction. These findings indicate a high prevalence and varying severity of autonomic dysfunction among the studied population. Participants with cardiac autonomic dysfunction had significantly higher HbA1c levels. Those with sympathetic dysfunction showed a mean HbA1c of 9.22 ± 1.73 versus 8.05 ± 1.33 in those without (p = 0.0221). Similarly, parasympathetic dysfunction was associated with higher HbA1c (9.25 ± 1.78 vs. 8.39 ± 1.33, p = 0.0413). HbA1c levels also increased with dysfunction severity: 7.75 ± 0.74 (no dysfunction), 8.84 ± 1.73 (mild), 9.07 ± 1.61 (moderate), and 10.92 ± 1.57 (severe), with a significant difference (p = 0.0001). These findings suggest a strong association between elevated HbA1c and the presence and severity of autonomic dysfunction. Conclusion: The study revealed a strikingly high prevalence of autonomic dysfunction: 79% parasympathetic and 87% sympathetic impairment, with 64% of participants exhibiting moderate-to-severe dysfunction. A pivotal finding was the robust association between elevated HbA1c levels and autonomic dysfunction severity (p = 0.0001), underscoring glycemic control as a key modifiable target. Notably, sustained handgrip tests identified 80% abnormal responses, advocating their utility in routine screening