Highlights in clinical autonomic neuroscience: Latest developments in the early detection of diabetic autonomic neuropathy

摘要

Autonomic neuropathy is a common and potentially serious complication of diabetes mellitus (Vinik et al., 2003). Cardiovascular autonomic neuropathy (CAN), in particular, has been associated with exercise intolerance, orthostatic hypotension, resting tachycardia, nocturnal blood pressure nondipping, intraoperative cardiovascular lability, silent myocardial ischemia and increased risk of mortality (Maser and Lenhard, 2005; Boulton et al., 2005). Early detection of diabetic autonomic neuropathy could guide treatment decisions prior to the development of serious manifestations and, in principle, lead to improved clinical outcomes. Accordingly, clinical testing for autonomic neuropathy has gained in use (Dyck et al., 1996). Intense interest has also developed in regard to the small fiber neuropathy that may be associated with prediabetes or impaired glucose tolerance (Boulton and Malik, 2010; Grandinetti et al., 2007; Dyck et al., 2007). A number of developments highlight recent progress in this field.