Cardiovascular autonomic neuropathy (CAN), a frequent complication of diabetes mellitus, may be one of the most overlooked of all serious complications of diabetes. Reduced heart rate variability is the earliest indicator of CAN. Using commercially manufactured noninvasive bedside instrumentation, CAN can be measured easily in a clinician's office. In addition, other manifestations of autonomic dysfunction in a diabetic patient may alert the clinician to the presence of CAN.
CAN is associated with a number of clinically significant manifestations including exercise intolerance, intraoperative cardiovascular lability, orthostatic hypotension, asymptomatic ischemia, painless myocardial infarction, and increased risk of mortality . These findings may cause the clinician to alter a patient's exercise regimen, increase surveillance for cardiac ischemia, and should influence the choice of medications that are prescribed. The identification of diabetic patients with CAN also could be helpful in preventing serious cardiac events.
This article provides an overview of assessment modalities for the determination of CAN, the importance of clinical identification, and risk factor associations of autonomic dysfunction. In addition, potential treatment interventions are addressed.
The Endocrinologist 2000; 10: 27-33