Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry

The CRONICAS Cohort Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1470-1478
Number of pages9
JournalDiabetic Medicine
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2015

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Type 2 Diabetes Mellitus
Area Under Curve
Pupil
Glucose Tolerance Test
Valsalva Maneuver
Orthostatic Hypotension
Routine Diagnostic Tests
Cross-Sectional Studies
Heart Rate
Light
Sensitivity and Specificity

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry. / The CRONICAS Cohort Study Group.

In: Diabetic Medicine, Vol. 32, No. 11, 01.11.2015, p. 1470-1478.

Research output: Contribution to journalArticle

The CRONICAS Cohort Study Group. / Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry. In: Diabetic Medicine. 2015 ; Vol. 32, No. 11. pp. 1470-1478.
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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.",
author = "{The CRONICAS Cohort Study Group} and Lerner, {A. G.} and Antonio Bernab{\'e}-Ortiz and R. Ticse and A. Hernandez and Y. Huaylinos and Pinto, {M. E.} and Germ{\'a}n M{\'a}laga and William Checkley and Gilman, {Robert H} and Miranda, {J. J.} and Casas, {Juan P.} and Smith, {George Davey} and Shah Ebrahim and Garc{\'i}a, {H{\'e}ctor H.} and Luis Huicho and {Jaime Miranda}, J. and Montori, {V{\'i}ctor M.} and Liam Smeeth and Diette, {Gregory B} and Fabiola Le{\'o}n-Velarde and Mar{\'i}a Rivera and Wise, {Robert A} and Katherine Sacksteder",
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T1 - Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry

AU - The CRONICAS Cohort Study Group

AU - Lerner, A. G.

AU - Bernabé-Ortiz, Antonio

AU - Ticse, R.

AU - Hernandez, A.

AU - Huaylinos, Y.

AU - Pinto, M. E.

AU - Málaga, Germán

AU - Checkley, William

AU - Gilman, Robert H

AU - Miranda, J. J.

AU - Casas, Juan P.

AU - Smith, George Davey

AU - Ebrahim, Shah

AU - García, Héctor H.

AU - Huicho, Luis

AU - Jaime Miranda, J.

AU - Montori, Víctor M.

AU - Smeeth, Liam

AU - Diette, Gregory B

AU - León-Velarde, Fabiola

AU - Rivera, María

AU - Wise, Robert A

AU - Sacksteder, Katherine

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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.

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