In part 4 of this Exclusive Interview, Aaron Vinik talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about the complexity and simplicity of measuring the balance of a patient’s autonomic nervous system.
Aaron Vinik MD, PhD, FCP, MACP, FACE is the Director of Research at Eastern Virginia Medical School in Norfolk, VA.
Transcript of this video segment:
Freed: So, what do we need to be able to measure the balance status, in a given individual?
Vinik: It’s actually complex and simple. So, you know that I am going to meet the Professor Sessions today? And they are talking about balance. So, I picked a case, well I picked a few, but I picked one long case. Just to take these endocrinologists through their ropes and to say to them, “I am going to show you a person that has everything wrong, that’s all fallen apart.” And then we will go through all the complex measures because they need to learn that now, but then I will show you the simple ones. The new EKG machine vomits out a couple of numbers, when you see it, it vomits out your heart rate, so that was the first number I told you. But it also vomits out the interval between the Q wave, the first deflection, the negative deflection, and the T wave is the recovery, the Q-T interval, and is corrected for right Q-T-C; that is the number it gives you. If your number if over 440, you’re in trouble. You want it to be under 440, and the heart rate I told you must be under 78. So, I’ve given you two numbers and you don’t have to do any work for it, you’re on the EKG, it’s there. The EKG these days also gives you two more measures. It gives you the RMSSD, the root mean square of the standard deviation of the RR interval or the SDN, that’s the standard deviation of the normal intervals. The SDN tells you how your whole body nervous system is functioning. The sympathetic, the parasympathetic, what’s happening in the brain, the hypothalamus, all that – just one number, SDN on that EKG. The RMSSD very nicely tells you what the parasympathetic nervous system is doing. So now you know all of those, one look at the EKG and you make your diagnosis of where you are.
Now I’ll take you back to your question, who’s being educated on this? Very few people. And who is going to prescribe cycloset? Only when they understand these numbers. So, the title of my presentation is, “Demystifying the Autonomic Nervous System.” Let’s get all you people in the same room and talk to you and start educating you about the numbers you need to know.
Freed: How does that information filter down to the practicing physician.
Vinik: Well, I mean the mission of AACE is to educate the practicing physician. Up until now, they’ve wanted to educate endocrinologists. Now they think they must turn Primary Care Doctors into endocrinologists. And so, they are going to have a very big drive to educate those people and I think that, that is the right thing to do. You have to get out there and educate the people who apply this but who, for this most part in this area, are ignorant.
Freed: Are there simple measures that can be made at the bedside as prognosticators of risk?
Vinik: The strange thing is the following: We’ve worked with a group of 200 Romanian physicians and we have information on 26,000 people with diabetes. We didn’t do a lot of work on them, we just got them to fill out a questionnaire. The questionnaire is the quality of life, a diabetic neuropathy questionnaire. It has been translated into 56 different languages and it is used worldwide as an endpoint for diagnosing neuropathy. With the Romanians, we had such a large quantity of people, so we could ask a lot of people the questions and then see what it told us. So, the first thing it told us that of the 26,000 people, 6,600 people had neuropathy by the definition of the tool and they didn’t know, nor did the doctors know. So, that is just an interesting discovery phenomenon.
So, at the ADA, you will see another nice paper and it says that if we take a section of questions out of that tool, just a small section of questions, we have now a new mortality of risk calculation. And it is done just with a few questions.