[Diabetic cardiovascular neuropathy]

Impairment of the autonomic nervous system is frequently detectable in diabetic patients. Symptoms and signs are less often observed but if present may be very important with regard to quality of life, metabolic control, and prognosis. Currently used methods to detect disturbances of the autonomic innervation of the cardiovascular system are easily performed, noninvasive, reliable and reproducible. They are not very time consuming and require only standard technical equipment allowing the quick identification of patients at risk. Damage of the cardiovascular autonomic nerve function may explain apparently disparate complaints and signs, i.e. orthostatic hypotension, painless myocardial ischemia, complications during anesthesia, postprandial hypotension and development of the diabetic food syndrome. The diagnosis of asymptomatic cardiovascular neuropathy should always induce attempts to intensify diabetes treatment because better metabolic control may improve or at least stop deterioration of nerve function.