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Diabetic autonomic neuropathy.

M J Stevens1, P J Watkins

  • 1Department of Diabetes, Kings College Hospital, London, U.K.

Acta Diabetologica Latina
|January 1, 1991
PubMed
Summary
This summary is machine-generated.

Diabetic neuropathy affects the heart early, causing rapid heart rate variability decline. Autonomic symptoms like postural hypotension impact survival, though overall prognosis is improving.

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Area of Science:

  • Cardiology
  • Neurology
  • Endocrinology

Background:

  • Diabetic neuropathy commonly affects the cardiovascular system, with heart rate variability declining significantly faster in diabetic patients.
  • The underlying causes of diabetic neuropathy remain unclear, with limited success in addressing metabolic factors like sorbitol and glucose.
  • Nerve ischemia and immunological damage are emerging as potential factors, with structural similarities between nerve growth factor and insulin noted.

Purpose of the Study:

  • To investigate the early manifestations of diabetic neuropathy, focusing on cardiovascular denervation and autonomic dysfunction.
  • To explore the potential role of nerve ischemia and immunological damage in the pathogenesis of diabetic neuropathy.
  • To evaluate the prognostic implications of autonomic neuropathy symptoms, particularly postural hypotension.

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Main Methods:

  • Assessed heart rate variability decline in diabetic patients compared to normal subjects.
  • Examined the effects of metabolic interventions on nerve tissue composition.
  • Investigated the clinical presentation and progression of autonomic neuropathy symptoms.
  • Analyzed the relationship between vascular tone, arterio-venous shunt flow, and foot complications.
  • Correlated the presence of autonomic symptoms with patient survival rates.

Main Results:

  • Heart rate variability declines at approximately 3 beats/min/year in diabetic patients, three times faster than in controls.
  • Autonomic neuropathy symptoms are rare but do not remit; postural hypotension is an uncommon consequence of reduced sympathetic vascular tone.
  • Abnormal vascular control in the neuropathic foot, including increased arterio-venous shunt flow, may contribute to neuroarthropathy and ulceration.
  • While abnormal heart rate variability alone has no prognostic value, symptoms like postural hypotension significantly reduce survival.
  • The majority of deaths in patients with diabetic neuropathy are attributed to concurrent renal disease and macrovascular atheroma.

Conclusions:

  • Cardiovascular denervation, specifically reduced heart rate variability, is an early sign of diabetic neuropathy.
  • Autonomic neuropathy, though often asymptomatic, can lead to significant complications like postural hypotension and impacts survival.
  • Understanding the pathogenesis and prognostic factors of diabetic autonomic neuropathy is crucial for patient management and improving outcomes.