Diagnosis and management of diabetic autonomic neuropathy

Abstract

Subclinical autonomic nerve damage occurs more widely in diabetics than was hitherto suspected and is assuming greater importance because of the implications for morbidity and mortality. Symptomatic autonomic neuropathy carries a worse prognosis than any other complication of diabetes. The simple bedside tests described above can provide an objective guide to whether or not autonomic damage is present, and to what degree. Some of the troublesome symptoms in the later stages can now be more successfully treated than before. The longer-term aim of management should, however, be the prevention or reversal of autonomic damage, particularly in its early stages.