"Bedside assessing ANS, RAAS, and IIR: a complex relation to type 2 diabetes".
Sergio Stagnaro, Biophysical Semeiotics Research Laboratory
15 November 2005
I can't agree with the paper's conclusions "In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance..." In my opinion, such statements are not completely true as well as misleading, as allows me to state a 48-year-long clinical experience . Firstly, nowadays doctors can fortunately "quantitatively" assess both autonomous nervous system (ANS) activity and renin-angiotensin-aldosterone-system (RAAS), circulating and tissural, in every biological system, although too much authors overlook this knowledge (1, 2, 3). As a matter of fact, the method used in their research in not right at all: for instance, it is well known that during physical exercise there is sympathetic overactivity in central adipose tissue and heart, but parasympathetic overactivity in muscles! Secondly, sympathetic overactivity appears always in the course of developing type 2 diabetes, but its CAEMH-dependent relation to IIR is quit complex (See http://www.semeioticabiofisica.it, my article "Beyond Hyperinsulinemia-Insulin Resistance in the War against Arteriosclerosis and type 2 Diabetes Mellitus" at the URL http://www.semeioticabiofisica.it/semeioticabiofisica/Documenti/Eng/Beyond%20Hyperinsulinemia%20engl.doc. Finally, physicians knowing Biophysical Semeiotics are able to evaluate at bedside, first, even AT BIRTH, "Diabetic AND Dyslipidaemic" constitutions, like Pre-Metabolic Syndrome and hyperinsulinaemia-insulinresistence, differentiating easily individuals with or without "diabetic" constitution; the latter will never become diabetic, of course (3,4,5) ,and finally type 2 diabetes, starting from its initial stage, by means of a lot of clinical tools, among them "pancreatic acute pick test of GH-RH secretion" (described in the above cited website, URL http://www.semeioticabiofisica.it/semeioticabiofisica/Documenti/Eng/Test%20del%20GH-RH%20DM%20eng..doc.
In conclusion, new ideas are difficult to be accepted; I thank for this reason... Cardiovascular Diabetology (6), even if they maybe highlightening old theories.
1) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale – Acta Med. Medit. 13, 99 1997
2) Stagnaro-Neri M, Stagnaro S., Valutazione clinica percusso-ascoltatoria del sistema nervoso vegetativo e del sistema renina-angiotensina, circolatorio e tessutale. Arch. Med. Int. XLIV, 17378. 1992
3) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm 2004
4) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/libro_costituzionisemeiotiche.htm 2004
5) Stagnaro S., Stagnaro-Neri M., Single Patient Based Medicine.La Medicina Basata sul Singolo Paziente: Nuove Indicazioni della Melatonina. Travel Factory, Roma, 2005. http://www.travelfactory.it/libro_singlepatientbased.htm 2005
Cardiovascular Diabetology
"Bedside assessing ANS, RAAS, and IIR: a complex relation to type 2 diabetes".
15 November 2005
I can't agree with the paper's conclusions "In frequency domain, the analysis of sympathetic (LF) and parasympathetic (HF) component evidenced an association between the offspring of type 2 diabetic subjects and a sympathetic overactivity. A global reduction and alteration of circadian rhythm of autonomic activity are present in offspring of type 2 diabetic patients with and without insulin resistance. The data of our study suggested that an autonomic impairment is associated with the familiarity for type 2 diabetes independently to insulin resistance and that an impairment of autonomic system activity could precede the insulin resistance..." In my opinion, such statements are not completely true as well as misleading, as allows me to state a 48-year-long clinical experience . Firstly, nowadays doctors can fortunately "quantitatively" assess both autonomous nervous system (ANS) activity and renin-angiotensin-aldosterone-system (RAAS), circulating and tissural, in every biological system, although too much authors overlook this knowledge (1, 2, 3). As a matter of fact, the method used in their research in not right at all: for instance, it is well known that during physical exercise there is sympathetic overactivity in central adipose tissue and heart, but parasympathetic overactivity in muscles! Secondly, sympathetic overactivity appears always in the course of developing type 2 diabetes, but its CAEMH-dependent relation to IIR is quit complex (See http://www.semeioticabiofisica.it, my article "Beyond Hyperinsulinemia-Insulin Resistance in the War against Arteriosclerosis and type 2 Diabetes Mellitus" at the URL http://www.semeioticabiofisica.it/semeioticabiofisica/Documenti/Eng/Beyond%20Hyperinsulinemia%20engl.doc. Finally, physicians knowing Biophysical Semeiotics are able to evaluate at bedside, first, even AT BIRTH, "Diabetic AND Dyslipidaemic" constitutions, like Pre-Metabolic Syndrome and hyperinsulinaemia-insulinresistence, differentiating easily individuals with or without "diabetic" constitution; the latter will never become diabetic, of course (3,4,5) ,and finally type 2 diabetes, starting from its initial stage, by means of a lot of clinical tools, among them "pancreatic acute pick test of GH-RH secretion" (described in the above cited website, URL http://www.semeioticabiofisica.it/semeioticabiofisica/Documenti/Eng/Test%20del%20GH-RH%20DM%20eng..doc.
In conclusion, new ideas are difficult to be accepted; I thank for this reason... Cardiovascular Diabetology (6), even if they maybe highlightening old theories.
1) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale – Acta Med. Medit. 13, 99 1997
2) Stagnaro-Neri M, Stagnaro S., Valutazione clinica percusso-ascoltatoria del sistema nervoso vegetativo e del sistema renina-angiotensina, circolatorio e tessutale. Arch. Med. Int. XLIV, 17378. 1992
3) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm 2004
4) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/libro_costituzionisemeiotiche.htm 2004
5) Stagnaro S., Stagnaro-Neri M., Single Patient Based Medicine.La Medicina Basata sul Singolo Paziente: Nuove Indicazioni della Melatonina. Travel Factory, Roma, 2005. http://www.travelfactory.it/libro_singlepatientbased.htm 2005
6) Stagnaro Sergio. Biophysical Semeiotic Constitutions, Genomics, and Cardio-Vascular Diseases. BMC Cardiovascular Disorders http://www.biomedcentral.com/1471-2261/4/20/comments#95454 2004
Competing interests
Not declared