What This Means
This research investigated which factors increase the risk of cardiovascular autonomic neuropathy (CAN) — a serious complication that affects the nerves controlling heart and blood vessel function — in people with type 2 diabetes. The study analyzed clinical data from 831 hospitalized patients and found that those who developed CAN tended to be older, have had diabetes longer, have worse blood sugar control (higher HbA1c), have signs of greater inflammation in the blood (higher NLR and PLR, which are ratios of different immune cells), and were more likely to also have diabetic eye disease (retinopathy). Conversely, CAN patients had lower levels of markers related to liver function, body size, and insulin production.
Using statistical methods to identify the strongest predictors, the researchers built a visual scoring tool called a nomogram that combines six factors — diabetic retinopathy, age, diabetes duration, HbA1c, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) — to estimate an individual patient's risk of having CAN. The model performed well, correctly identifying CAN in about 81% of cases in the development group and 71% in a separate validation group, with AUC values of 0.839 and 0.787 respectively, indicating good overall accuracy.
This research suggests that inflammatory markers routinely measured in blood tests — specifically NLR and PLR — may be useful alongside traditional risk factors like age and blood sugar control for identifying type 2 diabetes patients at higher risk of cardiovascular autonomic neuropathy. The presence of other diabetes complications, especially retinopathy, was also strongly associated with CAN risk. Such a predictive tool could help clinicians prioritize monitoring and care for patients most likely to develop this complication.