Assessment of cardiac autonomic neuropathy in young diabetics with postural orthostatic tachycardia syndrome (POTS)

Musharaf Bashir, Sheikh Imran Sayeed, Suhail Ahmad


BACKROUND: One of the serious complications of diabetes mellitus is cardiac autonomic neuropathy (CAN) which may lead to life threatening complications such as silent myocardial infarction. Autonomic neuropathy is one of the established causes of postural orthostatic tachycardia syndrome (POTS).

AIM:  In this study we performed various autonomic function tests in young diabetics who were diagnosed with POTS. Our aim was to assess the severity of CAN in them.

METHODS: 20 young diabetics mean age 16.5 years (SD 2.66) diagnosed with POTS were assessed for this study. Autonomic function tests such as deep breathing test (DBT),Valsalva ratio (VR), 30:15 ratio, lying to standing test (LST) and cold pressor test (CPT) were performed in all the subjects. Degree of CAN was assessed in them and categorized as per the severity.

RESULT: In these subjects we found that the symptoms of orthostatic intolerance such as headache, sweating, palpitations etc were present in all the subjects. Autonomic function tests that were deranged are DBT (5%), VR (1%), 30:15 ratio (1%), LST (50%) and CPT (15%). In these subjects 10% subjects had “Early CAN”, 30% had “Definite CAN” and 60% had “Severe CAN”.

CONCLUSION: Clinical assessment revealed that all the subjects had orthostatic intolerance and some degree of CAN. Further studies need to be carried out to assess the autonomic functions and severity of CAN in young diabetics with POTS for proper management which may help in improving quality of life in them.


POTS; cardiac autonomic neuropathy; type1 diabetes mellitus; adolescents;

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