SynthesisBMJ open diabetes research & care2021
Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis.
Synthesis in BMJ open diabetes research & care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Global Prevalence of Microvascular Complications in Children and Adolescents With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis.Pediatric diabetes · 2025Pooled it
- Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Heart Rhythm Society (LAHRS).Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Guideline
- Prevalence and Risk Factors of Cardiovascular Autonomic Neuropathy in Individuals with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.Reviews in cardiovascular medicine · 2024Pooled it
- ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents.Hormone research in paediatrics · 2024Guideline
- The association between distal symmetric polyneuropathy in diabetes with all-cause mortality - a meta-analysis.Frontiers in endocrinology · 2023Pooled it
- Peripheral and Autonomic Diabetic Neuropathy and Their Additive Risk of Major Adverse Liver Outcomes in Type 2 Diabetes.Advances in therapy · 2026Article
- Deleterious impact of obstructive sleep apnea on autonomic nervous system control during rapid-eye-movement sleep in adult type 1 diabetes.Physiological reports · 2026Article
- Diabetic peripheral neuropathy as an independent predictor of renal function decline in type 2 diabetes: a propensity score-matched retrospective cohort study using DPN-CheckClinical and experimental nephrology · 2026Article
- Validation of the Arabic version of the composite autonomic symptom score 31 questionnaire in diabetic autonomic neuropathy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- From Beat to Risk: How Heart Rate Variability Predicts Arrhythmias in Type 2 Diabetes.Life (Basel, Switzerland) · 2026Review
- Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal and metabolic responses to physical exercise in adults with type 1 diabetes.Diabetologia · 2026Article
- Development and validation of a nomogram model for predicting cardiac autonomic neuropathy in patients with diabetes.Frontiers in endocrinology · 2026Article
- Reduced heart rate variability predicts incident diabetic polyneuropathy.Frontiers in endocrinology · 2026Article
- Association of triglyceride glucose index with cardiovascular autonomic neuropathy in type 2 diabetes mellitus.Frontiers in cardiovascular medicine · 2026Article
- Relationship Between Physical Activity and Autonomic Responses in Adults with Type 2 Diabetes.International journal of environmental research and public health · 2025Observational
- Healthcare workers' knowledge, attitudes, and practices regarding diabetic cardiovascular autonomic neuropathy.Scientific reports · 2025Article
- Diagnostic value of heart rate-based methods for assessing cardiac autonomic neuropathy in prediabetes and diabetes.Physiological reports · 2025Article
- Correlation between Sirtuin 1 downregulation and reduced vitamin D receptor expression in patients with diabetic neuropathy.Acta diabetologica · 2025Article
- Validation of Monocular Pupillometry in Healthy Controls and Patients With Autonomic Dysfunction: Pupillary Biomarkers for Autonomic Failure.European journal of neurology · 2025Article
- Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We aimed to determine the prognostic association between cardiac autonomic neuropathy (CAN) and cardiovascular disease events (CVE) and mortality in type 1 and type 2 diabetes through a systematic review and meta-analysis. This systematic review and meta-analysis was registered with PROSPERO (CRD42020216305) and was conducted with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological criteria. CAN was defined on the basis of 1 (early/possible CAN) or ≥2 (definite CAN) positive autonomic function tests as per the Toronto Consensus guidelines. Studies included those with prospective CVE or mortality data. Methodological variables/risk of bias were assessed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) and RoB-2 (Risk-Of-Bias tool for randomized trials) appraisal tools. Electronic database searches yielded 18 467 articles; 84 articles were screened full-text, 26 articles fulfilled the inclusion criteria for quantitative synthesis. Sixteen studies from patients with (n=2875) and without (n=11 722) CAN demonstrated a pooled relative risk (RR) of 3.16 (95%CI 2.42 to 4.13; p<0.0001) of future CVE in favour of CAN. Nineteen studies provided all-cause mortality data from patients with (n=3679) and without (n=12 420) CAN, with a pooled RR of 3.17 (95%CI 2.11 to 4.78; p<0.0001) in favour of CAN. The risk of both future CVE and mortality was higher in type 1 compared with type 2 diabetes and with a definite CAN (vs possible CAN) diagnosis. Three studies were considered to have risk of serious bias. This study confirms the significant association between CAN and CVE and all-cause mortality. The implementation of population-based CAN screening will identify a subgroup with disproportionately higher cardiovascular and mortality risk that will allow for earlier targeted intervention.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.