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Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry

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dc.contributor.author Lerner, A. G.
dc.contributor.author Bernabe-Ortiz, A.
dc.contributor.author Ticse, R.
dc.contributor.author Hernandez, A.
dc.contributor.author Huaylinos, Y.
dc.contributor.author Pinto, M. E.
dc.contributor.author Malaga, G.
dc.contributor.author Checkley, W.
dc.contributor.author Gilman, R. H.
dc.contributor.author Miranda, J. J.
dc.date.accessioned 2019-02-06T14:52:18Z
dc.date.available 2019-02-06T14:52:18Z
dc.date.issued 2015
dc.identifier.uri http://doi.org/10.1111/dme.12752
dc.identifier.uri http://repositorio.upch.edu.pe/handle/upch/5301
dc.description.abstract AIM: To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy. METHODS: We conducted a cross-sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration-to-inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated. RESULTS: Data from 384 people, 213 with diabetes, were analysed. The mean (+/-sd) age of the people with diabetes was 58.6 (+/-8.2) years and in the control subjects it was 56.1 (+/-8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8-45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)]. CONCLUSIONS: Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool.
dc.language.iso eng
dc.publisher Wiley
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru
dc.subject Adult
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Sensitivity and Specificity
dc.subject Cross-Sectional Studies
dc.subject Aged
dc.subject Middle Aged
dc.subject Reproducibility of Results
dc.subject Early Diagnosis
dc.subject Mass Screening
dc.subject Autonomic Nervous System Diseases/complications/diagnosis/pathology/physiopathology
dc.subject Diabetes Mellitus, Type 2/complications/diagnosis/pathology/physiopathology
dc.subject Diabetic Cardiomyopathies/diagnosis
dc.subject Diabetic Neuropathies/diagnosis
dc.subject Diabetic Retinopathy/diagnosis
dc.subject Light
dc.subject Pupil/radiation effects
dc.subject Reflex, Pupillary/radiation effects
dc.title Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry
dc.type info:eu-repo/semantics/article
dc.identifier.journal Diabetic Medicine

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