الفهرس 
Acknowledgements
Diabetic Autonomic NeuropathyOnly 14 pages are availabe for public view
 |  | from | 179 |  |  |
| | | from | 179 | | |
Abstract
Diabetic autonomic neuropathy (DAN) is the least recognized and understood complication of diabetes mellitus despite its significant negative impact on survival and quality of life in diabetic patients (Handelsman et al., 2015). The diabetic autonomic neuropathy tends to affect multiple systems such as cardiovascular, urogenital, gastrointestinal, pupillomotor, thermoregulatory, and sudomotor (Sukla et al., 2016). Our study aimed to estimate the prevalence of diabetic autonomic neuropathy in Assuit university hospital, to evaluate the impact of diabetes duration and glycemic control on the development of diabetic autonomic neuropathy, and to detect the association between autonomic diabetic neuropathy and vascular stiffness. This is a non-blinded observational case-control study that was conducted on 152 diabetic patients. We recruited patients with type I DM on treatment for at least 5 years duration and patients with type II diabetes. All patients were admitted to the internal medicine department of Assuit university hospital from July 2017-to July 2019. Compared to 73 healthy control persons with no history of any chronic disease. For the total of 152 diabetic patients enrolled in our study (40 male and 112 female) with a mean of age 49.19 ± 11.9 and mean of BMI 29.73 ± 6.5 in comparison with 73 control healthy individuals (19 males and 54 females) with a mean of age 40.52 ± 10.6 and mean of BMI 26.93 ± 3.4. In our research, 87.5% of our patients were type II diabetic patients. All patients were evaluated by full history, clinical assessment, addressed the following questionnaires: (Urogenital Distress Inventory (UDI-6), The upper gastrointestinal symptom questionnaire, Pittsburgh Sleep Quality Index (PSQI), and International Index of Erectile Function Questionnaire or The Female Sexual Function Index (FSFI)), electrocardiogram, Ewing tests, fundus examination, laboratory tests (complete blood count, urine analysis, blood urea, serum creatinine, and liver function tests, random plasma glucose, HbA1c, lipid profile), echocardiography, abdominal ultrasound was performed to measure post voiding residual volume in the urinary bladder and to an indirect measure of gastric emptying, and intimal carotid thickening by carotid Doppler study. The prevalence of CAN was 54% in our patients, on the basis of abnormal cardiovascular autonomic reflex tests. Out of 152 participants, 13 patients (8.5%) were classified as early CAN, while 17 patients (11.1%) and 53 (34.9%) were classified as definite and severe (advanced) CAN respectively. As respects our outcomes, there is a negative correlation between the duration of diabetes & glycated hemoglobin and heart rate response to Valsalva, deep breathing, and standing. However, there is a positive correlation between the response of blood pressure to standing and the duration of diabetes & glycated hemoglobin. By utilizing intimal carotid thickness as a built-up marker for the subclinical atherosclerotic disease in the general population and diabetes (Lorenz et al., 2007), there was an increase in intimal carotid thickness (46 patients about 30.3% of diabetic patients) than the controlled group with significantly positive correlation with CAN, and increase the prevalence of diastolic dysfunction about 35.5 % with a statistically significant difference between patients and controlWe suggest that intimal carotid thickness measurement may be an alternative to cardiac autonomic function testing in hospitals where facilities for the latter test are inaccessible based on our results by using the ROC curve. Complications involving the GI tract are now recognized to be an important cause of morbidity in patients with diabetes mellitus (Talley et al., 2001). There was a significant difference in the gastrointestinal symptoms as regard abdominal pain (55.3%), gastroesophageal reflux (53.9%), vomiting (28.9%), constipation (35.5%), and diarrhea (15.1%) than the control group. Our results demonstrate that poor glycemic control and duration of diabetes are strongly associated with the presence of GI symptoms. Also, there was a significant delay in gastric emptying by abdominal ultrasound between patients ( 27.6%). and the control group (5.5%), moreover there was increases in delay gastric emptying in patients with moderate to severe abdominal pain, gastroesophageal reflux, vomiting, constipation. In this study, we aimed to assess the prevalence of urinary symptoms and post voiding residual in diabetic people compared to non-diabetics, as we found that urinary symptoms and increase in post voiding residual volume of urine are more prevalent in people with diabetes than in healthy people. as there were about 22 diabetic patients (14.5%) showed an increase in post voiding residual volume of urine comparing to (1.4%) of the controlled group. We are the first to use (UDI-6) score to assesses the bladder dysfunction in the diabetic patient as there is a statistically significant increase in the urogenital distress inventory (UDI-6) score among diabetic patients (Mean ± SD 4.05 ± 0.3) than the controlled group (Mean ± SD 1.73 ± 0.1). Also, we found that urinary frequency (71.7%) and urinary incontinence (50%) are exceedingly common than other urinary symptoms. Moreover, there is a moderate correlation between the Urogenital Distress Inventory score with the duration of diabetes. however, there was a high positive correlation between it and glycated hemoglobin.