Background
Methods
Study subjects
CAN assessments
Definition of CAN recovery
Demographic and clinical assessment
Statistical analysis
Results
Baseline and follow-up characteristics of study subjects according to CAN recovery
Non-recovery (n = 532) | Recovery (n = 227) | P value | |
---|---|---|---|
Age (years) | 61.4 ± 7.9 | 53.3 ± 10.8 | < 0.001 |
Male, n (%) | 294 (55.3) | 147 (64.8) | 0.015 |
Body weight (kg) | 65.8 ± 10.1 | 68.8 ± 12.7 | 0.001 |
Body mass index (kg/m2) | 24.9 ± 3.0 | 25.0 ± 3.4 | 0.783 |
Any use of alcohol, n (%) | 69 (13.0) | 39 (17.2) | 0.129 |
Current smoker, n (%) | 84 (15.8) | 32 (14.1) | 0.554 |
Duration of diabetes (years) | 11.5 ± 7.4 | 8.4 ± 6.2 | < 0.001 |
Systolic BP (mmHg) | 127.1 ± 15.7 | 125.2 ± 15.1 | 0.127 |
Diastolic BP (mmHg) | 76.2 ± 10.6 | 78.4 ± 11.7 | 0.010 |
Lipid profiles (mg/dL) | |||
Total cholesterol | 157.9 ± 28.8 | 161.5 ± 31.0 | 0.125 |
Triglycerides | 123.2 ± 55.1 | 136.4 ± 75.1 | 0.007 |
HDL-C | 51.4 ± 13.3 | 51.4 ± 13.6 | 0.937 |
LDL-C | 91.2 ± 25.6 | 93.5 ± 25.8 | 0.243 |
Fasting plasma glucose (mg/dL) | 144.7 ± 62.2 | 150.7 ± 52.7 | 0.204 |
HbA1c (%) | 7.4 ± 4.9 | 7.4 ± 1.6 | 0.939 |
HbA1c (mmol/mol) | 57.8 ± 53.2 | 57.5 ± 17.3 | 0.939 |
Fasting C-peptide (ng/ml)a | 2.2 ± 1.0 | 2.4 ± 1.2 | 0.041 |
Estimated GFR (mL/min/1.73 m2) | 79.8 ± 16.0 | 84.5 ± 16.2 | < 0.001 |
Other diabetic complications | |||
Presence of retinopathy, n (%)b | 93 (18.2) | 27 (12.4) | 0.054 |
Presence of micro/macroalbuminuria, n (%) | 96 (18.0) | 27 (11.9) | 0.035 |
Mean CIMT (mm)c | 0.79 ± 0.21 | 0.71 ± 0.19 | < 0.001 |
Use of insulin, n (%) | 53 (10.0) | 24 (10.6) | 0.799 |
Use of oral anti-diabetes drug, n (%) | 501 (94.2) | 210 (92.5) | 0.390 |
Use of statin, n (%) | 346 (65.0) | 130 (57.3) | 0.043 |
Use of anti-hypertensive drug, n (%) | 260 (48.9) | 75 (33.0) | < 0.001 |
ACE inhibitor or ARB | 225 (42.3) | 66 (29.1) | 0.001 |
Calcium channel blocker | 102 (19.2) | 23 (10.1) | 0.002 |
Thiazide | 83 (15.6) | 23 (10.1) | 0.109 |
Beta-blocker | 27 (5.1) | 10 (4.4) | 0.695 |
Diuretics | 83 (15.6) | 23 (10.1) | 0.028 |
Use of anti-platelet/anti-coagulant | 244 (45.9) | 62 (27.3) | < 0.001 |
Indices of heart rate variability | |||
Ln SDNN (ms) | 3.0 ± 0.5 | 3.1 ± 0.5 | 0.061 |
Ln RMSSD (ms) | 2.7 ± 0.6 | 2.7 ± 0.6 | 0.137 |
Ln LF (ms2) | 4.0 ± 1.2 | 4.2 ± 1.2 | 0.097 |
Ln HF (ms2) | 3.7 ± 1.2 | 3.9 ± 1.2 | 0.052 |
Ln LF:HF | 0.3 ± 1.0 | 0.4 ± 1.0 | 0.195 |
Total CAN score | 1.1 ± 0.3 | 1.1 ± 0.3 | 0.751 |
Change in variables (Δ) | Non-recovery (n = 532) | Recovery (n = 227) | P value |
---|---|---|---|
Δ Body weight (kg) | − 0.1 ± 3.3 | − 0.7 ± 3.4 | 0.047 |
Δ Body mass index (kg/m2) | − 0.1 ± 1.2 | − 0.2 ± 1.2 | 0.217 |
Δ Systolic BP (mmHg) | − 8.4 ± 17.4 | − 6.7 ± 18.0 | 0.218 |
Δ Diastolic BP (mmHg) | − 1.5 ± 29.7 | − 1.6 ± 11.0 | 0.935 |
Δ Total cholesterol (mg/dL) | − 6.8 ± 31.6 | − 9.9 ± 38.7 | 0.245 |
Δ Triglycerides (mg/dL) | 5.1 ± 58.4 | − 2.7 ± 75.8 | 0.126 |
Δ HDL-C (mg/dL) | 2.6 ± 24.9 | 0.9 ± 11.3 | 0.340 |
Δ LDL-C (mg/dL) | − 5.9 ± 34.1 | − 9.3 ± 33.6 | 0.212 |
Δ Fasting plasma glucose (mg/dL) | − 6.7 ± 66.7 | − 9.8 ± 58.7 | 0.540 |
Change in HbA1c | |||
ΔHbA1c (%) | 0.18 ± 1.18 | − 0.26 ± 1.23 | < 0.001 |
Mean HbA1c (%) | 7.1 ± 1.0 | 7.1 ± 0.9 | 0.850 |
Adjusted SD of HbA1c (%)a | 0.50 ± 0.45 | 0.48 ± 0.40 | 0.521 |
CV of HbA1c | 6.7 ± 5.8 | 6.4 ± 4.7 | 0.397 |
Change in medication | |||
Δ Use of insulin, n (%) | 24 (4.5) | 13 (5.7) | 0.477 |
Δ Use of oral anti-diabetes drug, n (%) | 205 (38.5) | 113 (49.8) | 0.004 |
Δ Use of statin, n (%) | 96 (18.0) | 41 (18.1) | 0.996 |
Δ Use of anti-hypertensive drug, n (%) | 133 (25.0) | 47 (20.8) | 0.214 |
Δ Use of anti-platelet/anti-coagulant, n (%) | 88 (16.5) | 27 (11.9) | 0.107 |
Change in indices of heart rate variability | |||
Δ Ln SDNN (ms) | − 0.02 ± 0.52 | 0.15 ± 0.45 | < 0.001 |
Δ Ln RMSSD (ms) | − 0.03 ± 0.64 | 0.02 ± 0.59 | 0.302 |
Δ Ln LF (ms2) | 0.33 ± 1.04 | 0.40 ± 1.07 | 0.341 |
Δ Ln HF (ms2) | − 0.04 ± 1.22 | 0.04 ± 1.06 | 0.384 |
Δ Ln LF:HF | 0.08 ± 1.23 | − 0.18 ± 1.23 | 0.009 |
Δ Total CAN score | 0.1 ± 0.4 | − 1.1 ± 0.2 | < 0.001 |
Clinical characteristics according to each category of CAN recovery
Clinical correlates for composite events of CAN recovery
Partial + complete recovery (n = 227) | ||||||
---|---|---|---|---|---|---|
Univariate OR (95% CI) | P value | Adjusted OR (95% CI)a | P value | Adjusted OR (95% CI)b | P value | |
Baseline variables | ||||||
Younger age (per 5-year decrease) | 1.62 (1.47–1.78) | < 0.001 | 1.49 (1.25–1.78) | < 0.001 | 1.52 (1.33–1.75) | < 0.001 |
Male | 1.49 (1.08–2.05) | 0.015 | 1.65 (0.87–3.13) | 0.124 | ||
Body weight (per 1 kg decrease) | 1.03 (1.01–1.04) | 0.001 | 1.02 (0.99–1.05) | 0.185 | ||
Duration of diabetes (per 5 year decrease) | 1.41 (1.24–1.59) | < 0.001 | 1.33 (1.05–1.67) | 0.016 | 1.37 (1.13–1.67) | 0.002 |
Diastolic BP (per 10 mmHg decrease) | 0.83 (0.72–0.96) | 0.010 | 0.94 (0.73–1.21) | 0.631 | ||
Triglycerides (per 10 mg/dL decrease) | 0.97 (0.94–0.99) | 0.008 | 0.99 (0.95–1.03) | 0.690 | ||
Fasting C-peptide (per 1 ng/mL increase)c | 0.86 (1.74–0.99) | 0.043 | 1.25 (0.96–1.62) | 0.092 | ||
Estimated GFR (per 10 mL/min/1.73 m2 increase) | 1.20 (1.09–1.33) | < 0.001 | 1.08 (0.91–1.28) | 0.396 | ||
Presence of retinopathy, yesd | 0.64 (0.40–1.01) | 0.056 | 1.35 (0.68–2.68) | 0.390 | ||
Presence of micro/macroalbuminuria, yes | 0.61 (0.39–0.97) | 0.037 | 0.34 (0.15–0.78) | 0.011 | 0.34 (0.16–0.75) | 0.007 |
Mean CIMT (per 1 mm decrese)e | 10.12 (2.87–35.69) | < 0.001 | 2.39 (0.56–10.19) | 0.238 | ||
Use of statin, yes | 0.72 (0.52–0.99) | 0.043 | 1.04 (0.61–1.78) | 0.890 | ||
Use of CCB or ACE inhibitor/ARB, yes | 0.52 (0.37–0.71) | < 0.001 | 0.88 (0.50–1.53) | 0.643 | ||
Use of anti-platelet/anti-coagulant, yes | 0.44 (0.32–0.62) | < 0.001 | 0.88 (0.50–1.55) | 0.659 | ||
Change in variables | ||||||
Δ body weight (per 1 kg decrease) | 1.05 (1.01–1.10) | 0.048 | 1.11 (1.02–1.21) | 0.016 | 1.10 (1.02–1.19) | 0.015 |
Δ HbA1c (per 1% decrease) | 1.36 (1.19–1.56) | < 0.001 | 1.32 (1.05–1.67) | 0.019 | 1.35 (1.08–1.67) | 0.007 |
Δ Change in oral anti-diabetes drug, yes | 1.60 (1.17–2.18) | 0.004 | 0.81 (0.47–1.42) | 0.465 |
Clinical correlates for the complete CAN recovery
Complete recovery (n = 9) | ||||||
---|---|---|---|---|---|---|
Univariate OR (95% CI) | P value | Adjusted OR (95% CI)a | P value | Adjusted OR (95% CI)b | P value | |
Baseline variables | ||||||
Younger age (per 5-year decrease) | 1.67 (1.26–2.20) | < 0.001 | 1.63 (1.07–2.49) | 0.023 | 1.67 (1.26–2.23) | < 0.001 |
Total cholesterol (per 10 mg/dL decrease) | 1.27 (0.97–1.67) | 0.088 | 1.24 (0.96–1.61) | 0.099 | ||
HbA1c (per 1% decrease) | 0.97 (0.94–1.00) | 0.065 | 1.54 (0.78–3.05) | 0.212 | ||
Change in variables | ||||||
Δ Change in oral anti-diabetes drug, yes | 4.94 (1.02–23.94) | 0.047 | 3.44 (0.65–18.07) | 0.145 | ||
Δ Change in anti-hypertensive drug, yes | 0.10 (0.02–0.52) | 0.006 | 0.96 (0.84–10.91) | 0.971 |
The relative significance of factors associated with CAN recovery
The association of change in HRV indices and total CAN score with change in clinical variables
Standardized β | ||||||
---|---|---|---|---|---|---|
Δ Ln SDNN | Δ Ln RMSSD | Δ LF | Δ HF | Δ LF: HF | Δ Total CAN score | |
Age (years) | − 0.070 | 0.021 | − 0.330 | 0.003 |
0.073*
|
0.266***
|
Sex (female) | − 0.050 | 0.023 | − 0.173*** | 0.030 | 0.002 | 0.064 |
Duration of diabetes (year) | − 0.057 | − 0.033 | 0.040 | − 0.032 |
0.086*
|
0.161***
|
Current smoking | 0.038 | 0.038 | 0.025 | 0.020 | 0.030 | 0.051 |
Δ Body weight (kg) | − 0.028 | − 0.020 | − 0.004 | − 0.041 | 0.015 |
0.074*
|
Δ BMI (kg/m2) | − 0.030 | − 0.024 | − 0.002 | − 0.041 | 0.022 | 0.049 |
Δ SBP (mmHg) | − 0.013 | 0.008 | − 0.017 | − 0.004 | 0.031 | − 0.012 |
Δ DBP (mmHg | 0.013 | 0.001 | 0.001 | 0.007 | 0.049 | 0.004 |
Δ Total cholesterol (mg/dL) | − 0.012 | − 0.020 | 0.010 | − 0.026 |
0.077*
| 0.002 |
Δ Triglycerides (mg/dL) | − 0.040 | − 0.080* | 0.049 | − 0.072 | 0.055 | 0.054 |
Δ HDL-C (mg/dL) | 0.017 | 0.015 | 0.008 | 0.037 | − 0.046 | 0.010 |
Δ LDL-C (mg/dL) | 0.015 | 0.002 | 0.033 | 0.026 | 0.046 | 0.014 |
Δ Fasting plasma glucose (mg/dL) | − 0.060 | − 0.006 | 0.026 | − 0.012 | 0.019 | 0.004 |
Δ HbA1c (%) | − 0.079* | − 0.044 | − 0.020 | − 0.043 | 0.045 |
0.248***
|
Mean HbA1c (%) | − 0.062 | − 0.070 | 0.036 | − 0.056 | 0.032 |
0.085*
|
Adjusted SD of HbA1c (%) | − 0.004 | − 0.040 | 0.060 | − 0.030 | − 0.022 |
0.083*
|
CV of HbA1c | 0.011 | − 0.029 | 0.053 | 0.011 | − 0.040 |
0.081*
|
Δ Change in insulin, yes | − 0.009 | − 0.002 | − 0.015 | 0.019 | 0.071 | 0.016 |
Δ Change in oral anti-diabetes drug, yes | 0.019 | − 0.020 | 0.025 | − 0.013 | − 0.029 | − 0.060 |
Δ Change in statin, yes | 0.032 | 0.012 | 0.030 | 0.015 | 0.001 | − 0.023 |
Δ Change in anti-hypertensive drug, yes | − 0.030 | − 0.031 | 0.066 | − 0.025 |
0.097**
|
0.175***
|
Δ Change in anti-platelet/anti-coagulant, yes | 0.046 | 0.062 | − 0.015 | 0.048 | 0.003 |
0.076*
|