Background. People with diabetic cardiovascular autonomic neuropathy (CAN) have increased cardiovascular mortality. However, the association between distal symmetric polyneuropathy (DSPN) or CAN with all-cause mortality is much less investigated. Thus, we set out to examine the effect of CAN and DSPN on all-cause mortality in a well-phenotyped cohort. Methods. All diabetes cases () from the catchment area of a secondary diabetes care centre who had medical examination including neuropathy assessment between 1997 and 2016 were followed up for all-cause mortality in the NHS Hungary reimbursement database until 2018. We investigated the association of CAN (Ewing tests) and DSPN (Neurometer) with all-cause mortality using Cox models stratified by diabetes type. Results. Altogether, persons with type 1/type 2 diabetes were included. Of the participants, 53%/43% were male, mean age was years, diabetes duration was years, 42%/29% had CAN, and 39%/37% had DSPN. During the -year follow-up, participants died. In fully adjusted models, participants with type 1 diabetes patients with versus without DSPN had an increased mortality (HR 2.99, 95% CI 1.4-8.63), while no association with CAN was observed. In type 2 diabetes, both DSPN and CAN independently increased mortality (HR 1.32, 95% CI: 1.07-1.64, and HR 1.44, 95% CI: 1.17-1.76). Conclusions. Our results are compatible with an increased risk of mortality in people with type 1 diabetes and DSPN. Furthermore, we report a similarly strong association between DSPN and CAN and all-cause mortality in type 2 diabetes mellitus.

中文翻译：

---

心血管自主神经病变和远端对称性多发性神经病变与全因死亡率的关系：一项回顾性队列研究

背景。患有糖尿病性心血管自主神经病变 (CAN) 的人心血管死亡率增加。然而，远端对称性多发性神经病 (DSPN) 或 CAN 与全因死亡率之间的关联研究较少。因此，我们着手研究 CAN 和 DSPN 对良好表型队列全因死亡率的影响。方法。所有糖尿病病例（)来自二级糖尿病护理中心的集水区，他们在 1997 年至 2016 年间接受了包括神经病变评估在内的医学检查，并在 NHS 匈牙利报销数据库中对全因死亡率进行了随访，直至 2018 年。我们调查了 CAN（尤因测试）和使用按糖尿病类型分层的 Cox 模型进行全因死亡率的 DSPN（神经计）。结果。共，包括 1 型/2 型糖尿病患者。在参与者中，53%/43% 为男性，平均年龄为 年，糖尿病病程为 年，42%/29% 有 CAN，39%/37% 有 DSPN。在此期间-年随访，参与者死亡。在完全调整的模型中，患有 1 型糖尿病的参与者与没有 DSPN 的参与者死亡率增加（HR 2.99, 95% CI 1.4-8.63），而没有观察到与 CAN 的关联。在 2 型糖尿病中，DSPN 和 CAN 均独立增加死亡率（HR 1.32，95% CI：1.07-1.64，HR 1.44，95% CI：1.17-1.76）。结论。我们的结果与 1 型糖尿病和 DSPN 患者的死亡风险增加相符。此外，我们报告了 DSPN 和 CAN 与 2 型糖尿病的全因死亡率之间类似的强关联。