Diabetic Autonomic Neuropathy: Present Insights and Future Prospects

TLDR: The contemporary position of diabetic autonomic neuropathy is presented and newer concepts of an enlarged autonomic nervous system, neuroendocrine aspects of autonomic dysfunction are increasingly being explored.

Abstract: Diabetic Autonomic Neuropathy: Present Insights and Future Prospects Autonomic neuropathy is now well recognized as a serious consequence of diabetes mellitus. Although most of the clinical features were described 40 yr ago, the pathophysiological understanding is still far from complete. There are several previous reviews,\" but recent advances make a further consideration of this subject appropriate. The past decade has seen gathering momentum in diabetic autonomic neuropathy research. Simple well-validated and noninvasive tests, particularly tests using cardiovascular reflexes, have now been refined for assessing autonomic nerve damage. Other simple tests involving pupillary, gastrointestinal, genitourinary, and sudomotor function are being developed. The direct recording of impulses conducted by autonomic nerve fibers is now possible with microneurography. With newer concepts of an enlarged autonomic nervous system, neuroendocrine aspects of autonomic dysfunction are increasingly being explored. Although these advances may not seem immediately relevant to the clinician, there have also been parallel developments in the study of the effect on neuropathy of improved glycemic control and newer treatments such as aldose reductase inhibitors and gangliosides. We present the contemporary position of diabetic autonomic neuropathy.