Work

External validation of a clinical risk score for the presence of cardiovascular autonomic neuropathy in type 1 diabetes

Year: 2025

Type: article

Abstract: AIMS: To validate in an independent external population a CAN Risk Score previously developed in type 1 diabetes (T1D) and validated for cardiovascular autonomic neuropathy (CAN) with a good diagnostic accuracy. METHODS: Forty-seven participants with T1D (age 47.7 ± 13.2 years, duration of diabetes 30.0 (19.0-40.5) years, 24 males) underwent 4 cardiovascular reflex tests (CARTs) to diagnose early and confirmed CAN (according to 1 or 2 abnormal results). CAN Risk Score was calculated from resting heart rate, HbA1c, retinopathy and/or nephropathy, cardiovascular disease, HDL cholesterol, systolic blood pressure and smoking (range 0-10). RESULTS: Eleven participants (23.4 %) had CAN. The CAN Risk Score was higher in subjects with overall CAN (early and confirmed) (P = 0.0498) and with confirmed CAN (P = 0.0142) compared to those without, and correlated with CARTs severity (rho = 0.32, P = 0.026), Expiration/Inspiration ratio (r = -0.33, P = 0.0258) and Valsalva ratio (r = -0.47, P = 0.0015). A CAN Risk Score ≥ 4 was found in 19 participants and was associated with the presence of confirmed CAN (P = 0.0129). The CAN Risk Score showed an area under the ROC curve (AUC) of 0.802 ± 0.080 for confirmed CAN, and at the cut-off of 4, sensitivity, specificity and negative predictive values of 85.71 %, 67.50 % and 96.43 %. CONCLUSIONS: This study confirmed the diagnostic value of the CAN Risk Score and supports its inclusion in a diagnostic algorithm to identify candidates for CARTs, thereby reducing universal screening. Using routinely available clinical data as categorical variables, the score is easy to calculate and implement in clinical settings.

Source: Journal of Diabetes and its Complications

DOI: 10.1016/j.jdiacomp.2025.109066

Authors: Pietro Pertile, Ilenia D'Ippolito, Beatrice De Santis, Aikaterini Andreadi, Davide Lauro, Vincenza Spallone

Institution: University of Rome Tor Vergata

Language: English

Topic: Diabetes Management and Research

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,760