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Impaired Hypoxic Ventilatory Drive in Diabetic Patients with Autonomic Neuropathy^*

Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, and Division of Endocrinology, University of Michigan Medical Center Ann Arbor, Michigan 48109

Address requests for reprints to: Aaron I. Vinik, M.D., D2226 Medical Professional Building, University of Michigan. Medical Center, 1405 East Ann Street, Ann Arbor, Michigan 48109.

The mortality of diabetic patients with autonomic neuropathy (DAN) is higher than that in those without autonomic neuropathy (DM). To test the hypothesis that this may be due to respiratory rather than cardiac dysfunction, we evaluated ventilatory responses to isocapnic-hypoxic and hyperoxic- hypercapnic conditions in 14 diabetic patients (8 DAN and 6 DM) and compared the results with those in 8 normal subjects.

In all groups tested there was a significant linear correlation between end-tidal CO₂ and minute ventilation and between endtidal CO₂ and mouth occlusion pressure (pl00), as an index of the drive to breathe. There were no significant- differences between the slopes and intercepts in the groups tested. A significant linear correlation was found between the O₂ saturation and both minute ventilation and p100. There were no significant differences in the relationship between minute ventilation and O₂ saturation, but the slopes and the intercepts of the regression lines of plOO us. O₂ saturation were significantly different in the DAN compared with those in normal subjects and DM. Additionally, five of eight patients with DAN lost their ventilatory drive and ventilatory responses to hypoxemia compared with only one of six DM. These findings suggest that a disorder in the ventilatory response to hypoxemia exists in some DAN.

^* This work was supported by a grant from the NIH (5-M01-RR-00042-22) to the Clinical Research Center.

Received July 9, 1985.

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