Diabetic distress, low-grade chronic inflammation, and cardiac autonomic neuropathy in internally displaced people (literature review and own observations)
Background. Internally displaced people (IDP) demonstrate an increased susceptibility to cardiovascular diseases and type 2 diabetes mellitus (T2DM). Negative psycho-traumatic experiences can lead to the development of emotional disorders, which further contribute to the onset of diabetic distress (...
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| Format: | Article |
| Language: | English |
| Published: |
Zaslavsky O.Yu.
2025-06-01
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| Series: | Mìžnarodnij Endokrinologìčnij Žurnal |
| Subjects: | |
| Online Access: | https://iej.zaslavsky.com.ua/index.php/journal/article/view/1563 |
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| Summary: | Background. Internally displaced people (IDP) demonstrate an increased susceptibility to cardiovascular diseases and type 2 diabetes mellitus (T2DM). Negative psycho-traumatic experiences can lead to the development of emotional disorders, which further contribute to the onset of diabetic distress (DD). Psychosocial risk factors for DD are largely associated with the risk of developing cardiac autonomic neuropathy (CAN) and, thus, adverse cardiovascular events. The Type 2 Diabetes Distress Assessment System (T2-DDAS) is the only specialized tool for assessing DD. The purpose: using the Ukrainian version of the T2-DDAS validated by us to assess the level of DD among IDP. Materials and methods. Development and application of a validated Ukrainian-language version of the Composite Autonomic Symptom Score 31 demonstrated that this is an acceptable tool for identifying patients with subclinical CAN. Results. Analysis of the results of short-term heart rate variability (HRV) shows that IDP with T2DM have a more significant suppression of parasympathetic nervous system (PSNS) activity and an increase in sympathetic nervous system (SNS) activity. This may indicate adaptive reactions that occurred against the background of stressful situations. In addition, HRV changes typical of states of intense neuro-emotional stress were recorded, which may suggest prolonged activation of the SNS. The changes detected indicate an early disturbance of the PSNS, which is one of the first signs of CAN in T2DM. Psychological stress can activate the SNS, which in turn contributes to the development of low-grade chronic inflammation. We have found that IDP with T2DM and subclinical CAN had the most pronounced insulin resistance. In addition, there was a significant increase in the level of high-sensitivity C-reactive protein, tumor necrosis factor α, as well as the tumor necrosis factor α/interleukin 10 ratio in the blood. Conclusions. Thus, the measurement of short-term HRV in combination with the determination of proinflammatory marker levels provides an opportunity to more accurately assess the risk of developing CAN in patients with T2DM. |
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| ISSN: | 2224-0721 2307-1427 |