TY - JOUR
T1 - Vitamin B12 deficiency is associated with cardiovascular autonomic neuropathy in patients with type 2 diabetes
AU - Hansen, Christian S
AU - Jensen, Jan S
AU - Ridderstråle, Martin
AU - Vistisen, Dorte
AU - Jørgensen, Marit E
AU - Fleischer, Jesper
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - AIMS: Vitamin B12 deficiency could be associated with cardiovascular autonomic neuropathy (CAN) in diabetes patients. We aim to investigate the association between serum levels of vitamin B12 and CAN in type 2 diabetes patients.METHODS: 469 ambulatory type 2 diabetes patients (mean diabetes duration 10.0years (IQR 5.0;17.0), mean age 59.0years (SD 11.6), 63% men, mean B12 289.0pmol/l (IQR 217;390)) were screened for CAN using three cardiovascular reflex tests, five minute resting heart rate (5min RHR) and heart rate variability indices.RESULTS: Serum levels of vitamin B12 were significantly lower in patients treated with metformin and/or proton pump inhibitors (PPIs) compared with patients not treated (p<0.001). A 25pmol/l higher level of vitamin B12 was associated with an odds ratio of the CAN diagnosis of 0.94 (95% CI 0.88; 1.00, p=0.034), an increase in E/I-ratio of 0.21% (95% CI 0.01; 0.43, p=0.038), and a decrease in 5min RHR of 0.25 beats per minute (95% CI -0.47; -0.03, p=0.025).CONCLUSION: Vitamin B12 may be inversely associated with CAN in patients with type 2 diabetes. Confirmatory studies investigating a causal role of vitamin B12 for the development of diabetic CAN are warranted.
AB - AIMS: Vitamin B12 deficiency could be associated with cardiovascular autonomic neuropathy (CAN) in diabetes patients. We aim to investigate the association between serum levels of vitamin B12 and CAN in type 2 diabetes patients.METHODS: 469 ambulatory type 2 diabetes patients (mean diabetes duration 10.0years (IQR 5.0;17.0), mean age 59.0years (SD 11.6), 63% men, mean B12 289.0pmol/l (IQR 217;390)) were screened for CAN using three cardiovascular reflex tests, five minute resting heart rate (5min RHR) and heart rate variability indices.RESULTS: Serum levels of vitamin B12 were significantly lower in patients treated with metformin and/or proton pump inhibitors (PPIs) compared with patients not treated (p<0.001). A 25pmol/l higher level of vitamin B12 was associated with an odds ratio of the CAN diagnosis of 0.94 (95% CI 0.88; 1.00, p=0.034), an increase in E/I-ratio of 0.21% (95% CI 0.01; 0.43, p=0.038), and a decrease in 5min RHR of 0.25 beats per minute (95% CI -0.47; -0.03, p=0.025).CONCLUSION: Vitamin B12 may be inversely associated with CAN in patients with type 2 diabetes. Confirmatory studies investigating a causal role of vitamin B12 for the development of diabetic CAN are warranted.
KW - Antihypertensive Agents/therapeutic use
KW - Autonomic Nervous System Diseases/complications
KW - Cardiovascular Diseases/complications
KW - Cohort Studies
KW - Cross-Sectional Studies
KW - Denmark/epidemiology
KW - Diabetes Mellitus, Type 2/blood
KW - Diabetic Angiopathies/complications
KW - Diabetic Cardiomyopathies/complications
KW - Diabetic Neuropathies/complications
KW - Female
KW - Heart Rate/drug effects
KW - Humans
KW - Hypertension/complications
KW - Hypoglycemic Agents/therapeutic use
KW - Male
KW - Mass Screening
KW - Metformin/therapeutic use
KW - Middle Aged
KW - Prevalence
KW - Proton Pump Inhibitors/therapeutic use
KW - Risk Factors
KW - Vitamin B 12/blood
KW - Vitamin B 12 Deficiency/complications
U2 - 10.1016/j.jdiacomp.2016.08.025
DO - 10.1016/j.jdiacomp.2016.08.025
M3 - Journal article
C2 - 27638143
VL - 31
SP - 202
EP - 208
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
SN - 1056-8727
IS - 1
ER -