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Autonomic neuropathy in diabetes.

Lucianne Righeti Monteiro Tannus1, Roberta Arnoldi Cobas1

  • 1Departamento de Clínica Médica, Unidade de Diabetes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

Archives of Endocrinology and Metabolism
|November 28, 2025
PubMed
Summary

Diabetic autonomic neuropathy (DAN) is a serious diabetes complication affecting the autonomic nervous system (ANS). This review aids clinicians in recognizing and managing DAN

Keywords:
Diabetic neuropathycardiovascular autonomic neuropathydiabetes mellitusdiabetic autonomic neuropathyheart rate variability

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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.