Diabetic autonomic neuropathy and the heart

This brief review summarises the relationship between autonomic nerve damage, diabetes, and the heart. Clinical aspects of cardiac autonomic involvement are first considered, then the evidence, both direct and indirect, for cardiac autonomic nerve involvement is reviewed. This evidence includes studies of heart rate, cardiovascular reflexes, heart rate variability, QT interval length, cardiac function, pathological studies, and cardiac scintiscanning. Brief consideration is given to the relation with other aspects of diabetes and treatment to prevent or reverse autonomic damage. Potential future research directions are then proposed.