Evaluating the Schematic Assessment of Impact of Glycaemic Control on Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus, A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.36283/ziun-pjmd15-2/030Keywords:
Diabetic Neuropathies, Diabetes Mellitus, Diabetes Mellitus Type 2, Valsalva Maneuvers, Heart Rate, Glycaemic Control, Percutaneous Coronary InterventionAbstract
Background: Cardiac autonomic neuropathy (CAN) is a severe, poorly known complication of type 2 diabetes mellitus (T2DM), which is the loss of autonomic control of heart rate and blood pressure and is linked to morbidity and mortality. This meta-analysis and systematic review aimed to determine the effect of interventional measures on the cardiac autonomic function of patients with type 2 diabetes mellitus (T2DM).
Methods: An extensive search in PubMed, Scopus, Web of Science, and Google Scholar until November 2025 was conducted. The randomized controlled trials, the prospective cohort studies, and the observational studies that measure cardiac autonomic functioning in patients with T2DM were covered. Risk of bias of the included observational and interventional studies was assessed using the Newcastle–Ottawa Scale (NOS) for cohort and cross-sectional studies, and the Cochrane ROB tool for randomized trials; and the degree of certainty of evidence was gauged through the GRADE method.
Results: 12 studies passed the inclusion criteria. The meta-analysis of both primary outcomes; E: I ratio and Valsalva ratio showed no statistically significant improvements, respectively. There was a high heterogeneity (I2 = 95-98%), which could probably be explained by the variation in the nature of patients, types of interventions, and protocols of measurement. The rigor of findings was ensured by subgroup and sensitivity analysis.
Conclusion: T2DM patients have mixed effects on cardiac autonomic functioning in terms of interventions. Non-pharmacological and multimodal approaches have the potential to be of value, particularly in optimal glycaemic control, yet standardized trials are needed to offer certain directions.
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