[Autonomic neuropathies in diabetes mellitus: diagnosis--therapy--risks]

Autonomic neuropathy is a complication of diabetes which is observed in about 20% of all patients. This complication is often not adequately diagnosed. Neuropathy is a syndrome of various diseases that is classified according to the organs involved in the clinical picture. For the diagnosis of autonomic neuropathy besides the careful examination of the patient (metabolic and neurologic status, diabetic complications) a number of specific tests are available i.e. cardiovascular reflex tests and some other organ-specific tests. The review attempts to give an update of the presently used diagnostic approaches. As far as the therapy of all forms of neuropathy is concerned the careful control of blood glucose of the diabetic patient is still the only therapy which counteracts specifically the pathogenesis of autonomic neuropathy. There is however a number of drugs available which are useful for symptomatic therapy. Their effectiveness is discussed in this review. There is no doubt that diabetic autonomic neuropathies will have consequences for long-term prognosis and quality of life.