Diagnosing Diabetic Autonomic Neuropathy - Diabetic Autonomic Neuropathy Diagnosis and Tests

Diagnosing Diabetic Autonomic Neuropathy

Ask the Experts about Diabetes & Endocrinology
from Medscape Diabetes & Endocrinology

Question

What is the approach to diagnosing diabetic autonomic neuropathy?

Response from Aaron I. Vinik, MD, PhD
Professor of Medicine, Pathology, and Neurobiology, Department of Internal Medicine, and Research Director, Strelitz Diabetes Institutes, Eastern Virginia Medical School, Norfolk, Virginia

Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting both proximal and distal, peripheral sensory and motor, as well as the autonomic nervous system (ANS). The ANS supplies all organs in the body and consists of an afferent and an efferent system, with long efferents in the vagus (cholinergic) and short postganglionic unmyelinated fibers in the sympathetic system (adrenergic). A third component is the neuropeptidergic system, with its neurotransmitters substance P (SP), vasoactive intestinal polypeptide (VIP), and calcitonin gene-related peptide (CGRP), among others.

Diabetic autonomic neuropathy (DAN) can cause dysfunction of every part of the body. "Know DAN and you know the whole of medicine." DAN often goes completely unrecognized by patient and physician alike because of its insidious onset and protean multiple organ involvement. Alternatively, the appearance of complex and confusing symptoms in a single organ system due to DAN may cause profound symptoms and receive intense diagnostic and therapeutic attention. Subclinical involvement may be widespread, whereas clinical symptoms and signs may be focused within a single organ. The organ systems that most often exhibit prominent clinical autonomic signs and symptoms in diabetes include the cardiovascular system, gastrointestinal tract system, genitourinary system, sweat glands, adrenal medullary system, and the ocular pupil (Table 1).

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