Diabetic autonomic neuropathy
Diabetic autonomic neuropathy
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Author
Martin J Stevens, MD
Section Editors
Jeremy M Shefner, MD, PhD
David M Nathan, MD
Deputy Editor
John F Dashe, MD, PhD
Last literature review version 16.3: October 2008 | This topic last updated: May 17, 2007 (More)
INTRODUCTION — Diabetic autonomic neuropathy (DAN) is classified as subclinical or clinical depending upon the presence or absence of symptoms. A wide spectrum of symptoms affecting many different organ systems can occur, including the cardiovascular, gastrointestinal, genitourinary, pupillary, sudomotor and neuroendocrine systems (show table 1).
MULTIFACTORIAL RISK FACTOR REDUCTION — The therapy of diabetic autonomic neuropathy (DAN) can be difficult. It is therefore desirable to prevent this complication or, once established, to slow disease progression.
Poor glucose control and vascular risk factors appear to be associated with the development of diabetic neuropathy. This observation is supported by the results of the EURODIAB study, which found that the incidence of neuropathy was associated with poor glucose control, elevated triglyceride levels, elevated body mass index, smoking, and hypertension [1]. (See "Pathogenesis and prevention of diabetic polyneuropathy", section on Risk factors).
However, results from a large prospective observational study suggest that the incidence of DAN is declining in type 1 diabetes, potentially reflecting improvements in the management of risk factors [2].
The potential efficacy of intensive combined therapy in patients with type 2 diabetes and microalbuminuria was examined in the Steno type 2 trial [3]. In this prospective study, 160 patients were randomly assigned to standard or multifactorial intensive therapy. The intensive regimen consisted of behavioral therapy (including advice concerning diet, exercise, and smoking cessation) and pharmacologic intervention (consisting of the administration of multiple agents to attain several aggressive therapeutic goals) (show table 2). DAN was present at baseline in 28 percent.
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