Diabetic Autonomic Neuropathies as Complications of Insulin and Non-insulin Dependent Diabetes Mellitus

摘要

Changes in human behaviour and lifestyle over the lastcentury have resulted in a dramatic increase in the incidence ofdiabetes worldwide. Diabetic autonomic neuropathies are aheterogeneous and progressive disease entity which is commonlyseen to complicate both type 1 and type 2 diabetes mellitus. Althoughthe etiology is unclear, lack of insulin, hyperglycemia, autoimmunemimicking mechanisms and metabolic abnormalities are thought toplay a pivotal role. A subgroup of diabetic autonomic neuropathy(DAN), cardiovascular autonomic neuropathy (CAN), which is one ofthe classical complications of diabetes mellitus (DM), but yet, one ofthe least frequently diagnosed, is ultimately important because of itscorrelation with increased mortality. The natural history of CAN isnot well understood, but is thought to develop from a subclinicalstage characterized by an impaired baroreflex sensitivity andabnormalities of spectral analysis of heart rate variability... Thepathogenesis of CAN is complex and involves a cascade of pathwaysactivated by hyperglycemia eventually resulting in progressiveneuronal ischemia and cellular death. Early diagnosis of CAN, usingscintigraphic imaging techniques or spectral analysis of heart ratevariability might pave way for screening of patients at highest riskfor the development of CAN and, thereby, enable the targeting ofintensive therapeutic approaches. No form of therapy in DAN hasbeen identified that provides unequivocal, safe, and effectivestabilization or reversal of the condition The aim of this article is toreview the epidemiology, potential causes and consequences,diagnosis and promising therapeutic approaches of diabeticautonomic neuropathy.