Abstract
Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes, often overlooked and misdiagnosed. It is a systemic-wide disorder that may be asymptomatic in the early stages. The most studied and clinically important form of DAN is cardiovascular autonomic neuropathy defined as the impairment of autonomic control of the cardiovascular system in patients with diabetes after exclusion of other causes. The reported prevalence of DAN varies widely depending on inconsistent definition, different diagnostic method, different patient cohorts studied. The pathogenesis is still unclear and probably multifactorial. Once DAN becomes clinically evident, no form of therapy has been identified, which can effectively stop or reverse it. Prevention strategies are based on strict glycemic control with intensive insulin treatment, multifactorial intervention, and lifestyle modification including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise. The present review summarizes the latest knowledge regarding clinical presentation, epidemiology, pathogenesis, and management of DAN, with some mention to childhood and adolescent population.
Highlights
DEFINITION Diabetic neuropathy is the main cause of neuropathy in the world [1]
Considered for a long time in the past century as a rare event, Diabetic autonomic neuropathy (DAN) is a serious and often underestimated complication of diabetes for two main reasons: by potentially affecting any circuit/tract of autonomic nervous system, DAN is a systemic-wide disorder, which encompasses a large spectrum of organs and leads to significant increase in morbidity and mortality [6,7,8]; DAN in early stages may be asymptomatic, especially in young T1DM patients, often compromising early diagnosis and treatment
Subclinical DAN can occur within a year of diagnosis in T2DM and within 2 years in T1DM, while first symptoms may onset after years [6, 9, 10]
Summary
DEFINITION Diabetic neuropathy is the main cause of neuropathy in the world [1]. As one of the major complications [2], it plays a key role in morbidity and mortality in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). Diabetic autonomic neuropathy of this finding with other risk factors like lung microvascular complications, endocrine impairments, obesity, and hypertension, lead to a higher prevalence of sleep apnea syndrome (SAS) in diabetic patient [18, 19].
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