[Possibilities of early diagnosis of autonomic neuropathy in diabetics]

The possibilities of the diagnosis of autonomous neuropathy were investigated by the authors in 71 insulin-treated diabetes mellitus patients with the use of dynamic esophageal scintigraphy and determination of cardiac reflex tests. It has been found that the extent and severity of the lesion can be earlier and more exactly recognized with the help of these two methods. Important information can be obtained by the determination of esophageal transit time about the functional condition of vagal nerves supplying gastrointestinal organs. In patients suffering from autonomous neuropathy the esophageal transit time proved to be significantly prolonged (p less than 0.01). The injury of parasympathetic heart innervation is earlier indicated by the pulmo-cardiac reflexes, while the troubles of symphathic functions are shown more responsively by the sustained handgrip test. Cases with considerable degree of orthostatic hypotension were not observed, its incidence may be probably higher only in advanced forms of autonomous neuropathy. The injury of vegetative nerve fibers develops mostly parallel in diabetes mellitus, but partial functional disorders can be also observed. Detailed neurological examinations were performed in 30 patients, and it has been found, that the lesion of peripheral nerves can be only later observed. Specific complications involving the nervous system are more frequent in cases with longer duration of the disease. In the authors opinion, for investigation and follow-up of larger number of diabetic patients, the dynamic esophageal scintigraphy and determination of pulmo-cardiac reflex and sustained handgrip tests seem to be suitable.