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Diabetic autonomic neuropathy

Jeremy M Shefner, MD, PhD
Section Editor
David M Nathan, MD
Deputy Editor
John F Dashe, MD, PhD


Diabetic autonomic neuropathy (DAN) is classified as subclinical or clinical depending upon the presence or absence of symptoms. A wide spectrum of symptoms affecting many different organ systems can occur, including the cardiovascular, gastrointestinal, genitourinary, pupillary, sudomotor, and neuroendocrine systems (table 1).


The therapy of diabetic autonomic neuropathy (DAN) can be difficult. It is therefore desirable to prevent this complication or, once established, to slow disease progression.

Poor glucose control and vascular risk factors appear to be associated with the development of diabetic neuropathy [1]. This observation is supported by the results of the EURODIAB study, which found that the incidence of neuropathy was associated with poor glucose control, elevated triglyceride levels, elevated body mass index, smoking, and hypertension [2]. (See "Pathogenesis and prevention of diabetic polyneuropathy", section on 'Risk factors'.)

However, results from a large prospective observational study suggest that the incidence of DAN is declining in type 1 diabetes, potentially reflecting improvements in the management of risk factors [3].

In the Diabetes Control and Complications Trial (DCCT), intensive therapy with insulin in subjects with type 1 diabetes was found to reduce cardiovascular autonomic neuropathy incidence by 53 percent [4], and the benefit of prior intensive therapy was found to persist for up to 14 years in these subjects [5].


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Literature review current through: Apr 2017. | This topic last updated: Jan 05, 2017.
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