Autonomic neuropathy in diabetes

Area of Science:

• Endocrinology and Metabolism
• Neurology
• Cardiology

Background:

• Diabetic autonomic neuropathy (DAN) is a significant complication of diabetes mellitus.
• It affects various parts of the autonomic nervous system (ANS), leading to diverse symptoms.
• Cardiovascular autonomic neuropathy (CAN) is a severe form linked to increased mortality.

Purpose of the Study:

• To provide a practical understanding of DAN for clinicians.
• To aid in the suspicion, investigation, and management of DAN.
• To focus on cardiovascular (CV), gastrointestinal (GI), and genitourinary (GU) manifestations.

Main Methods:

• Integration of basic science, epidemiological, and clinical data.
• Review of pathophysiology, clinical presentation, and management strategies.
• Focus on under-recognized aspects of DAN in clinical practice.

Main Results:

• DAN involves complex hyperglycemia-driven pathways, oxidative stress, and inflammation.
• Symptoms extend beyond CV issues to include GI, GU, and sudomotor dysfunction.
• DAN is often overlooked due to subclinical onset and non-specific symptoms.

Conclusions:

• DAN significantly impairs quality of life and is often under-recognized.
• Early recognition and management are crucial for patient outcomes.
• This review offers a guide for clinicians to address CV, GI, and GU manifestations of DAN.