Subject    :    [2019 Feb;43(1)] Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet
Writer KDA
Date 2019-03-06 10:18:04 Hit 92
Diabetes Metab J. 2019 Feb;43(1):3-30. English.
Published online Nov 02, 2018.  https://doi.org/10.4093/dmj.2018.0259 
Copyright © 2019 Korean Diabetes Association
   
Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet
Vincenza Spallone
Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Corresponding author: Vincenza Spallone. Division of Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy. Email: vispa@mclink.it 
 
Received January 14, 2019; Accepted February 01, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

 
Abstract

The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to increase due to the diabetes epidemic and its early and widespread appearance. CAN has a definite prognostic role for mortality and cardiovascular morbidity. Putative mechanisms for this are tachycardia, QT interval prolongation, orthostatic hypotension, reverse dipping, and impaired heart rate variability, while emerging mechanisms like inflammation support the pervasiveness of autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: by promoting screening for symptoms and signs; by simplifying cardiovascular reflex tests; and by selecting the candidates for screening. CAN assessment allows for treatment of its manifestations, cardiovascular risk stratification, and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, whereas multifactorial intervention might be effective in T2DM. Lifestyle intervention improves autonomic function mostly in pre-diabetes. While there is no conclusive evidence for a disease-modifying therapy, treatment of CAN manifestations is available. The modulation of autonomic function by SGLT2i represents a promising research field with possible clinical relevance.

   
Keywords:
Autonomic nervous systemCardiovascular systemDiabetic neuropathiesDiagnosisEpidemiologyGlucagon-like peptide-1 receptorHypotension, orthostaticPrognosisSodium-glucose transporter 2 inhibitorsTherapeutics

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