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The handgrip test - A historical test for diabetic autonomic neuropathy or a marker of something else?

Anna Erzsébet Körei1, Zsuzsanna Putz1, Orsolya Erzsébet Vági1

  • 1Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary.

Journal of Diabetes and Its Complications
|January 19, 2024
PubMed

Insights

Cardiovascular autonomic neuropathy (CAN) diagnosis is vital in diabetes. The review highlights that the isometric handgrip test is no longer recommended for evaluating sympathetic dysfunction in CAN assessments.

Area of Science:

  • Cardiology
  • Endocrinology
  • Neurology

Background:

  • Cardiovascular autonomic neuropathy (CAN) is a common diabetes complication, increasing patient morbidity and mortality.
  • Early and accurate CAN diagnosis is critical for managing diabetic patients.
  • Standard cardiovascular reflex tests (CARTs) are established methods for CAN assessment.

Purpose of the Study:

  • To review the historical context of CARTs for CAN assessment.
  • To present the latest evidence regarding the isometric handgrip test (IHT) in CAN evaluation.
  • To discuss the evolving role of IHT in assessing diabetic patients.

Main Methods:

  • Review of historical data and established protocols for CARTs.
  • Analysis of recent studies and clinical evidence on IHT efficacy.
  • Synthesis of findings related to IHT in diabetic and non-diabetic populations.

Main Results:

  • The diastolic blood pressure response to sustained handgrip exercise is no longer a recommended clinical test for CAN.
  • Growing evidence suggests IHT should be removed from standard CAN assessment protocols for diabetic patients.
  • IHT results correlate with hypertension parameters and target-organ damage, suggesting a potential screening role for cardiovascular risk.

Conclusions:

  • The isometric handgrip test is not advised for evaluating sympathetic dysfunction in diabetic CAN.
  • IHT may serve as a screening tool for identifying high cardiovascular risk in patients with hypertension.
  • Further research is needed to fully define the role of IHT in cardiovascular risk stratification.

Keywords:
Cardiovascular autonomic neuropathyCardiovascular reflex testsDiabetes mellitusHypertensionIsometric handgrip test

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