Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management

Vincenza Spallone, Dan Ziegler, Roy Freeman, Luciano Bernardi, Simona Frontoni, Rodica Pop-Busui, Martin Stevens, P. Kempler, Jannik Hilsted, Solomon Tesfaye, Phillip Low, Paul Valensi

Research output: Contribution to journalArticle

336 Citations (Scopus)

Abstract

The Cardiovascular Autonomic Neuropathy (CAN) Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy worked to update CAN guidelines, with regard to epidemiology, clinical impact, diagnosis, usefulness of CAN testing, and management. CAN is the impairment of cardiovascular autonomic control in the setting of diabetes after exclusion of other causes. The prevalence of confirmed CAN is around 20%, and increases up to 65% with age and diabetes duration. Established risk factors for CAN are glycaemic control in type 1 and a combination of hypertension, dyslipidaemia, obesity, and glycaemic control in type 2 diabetes. CAN is a risk marker of mortality and cardiovascular morbidity, and possibly a progression promoter of diabetic nephropathy. Criteria for CAN diagnosis and staging are: (1) one abnormal cardiovagal test result identifies possible or early CAN; (2) at least two abnormal cardiovagal test results are required for definite or confirmed CAN; and (3) the presence of orthostatic hypotension in addition to abnormal heart rate test results identifies severe or advanced CAN. Progressive stages of CAN are associated with increasingly worse prognosis. CAN assessment is relevant in clinical practice for (1) diagnosis of CAN clinical forms, (2) detection and tailored treatment of CAN clinical correlates (e.g. tachycardia, orthostatic hypotension, non-dipping, QT interval prolongation), (3) risk stratification for diabetic complications and cardiovascular morbidity and mortality, and (4) modulation of targets of diabetes therapy. Evidence on the cost-effectiveness of CAN testing is lacking. Apart from the preventive role of intensive glycaemic control in type 1 diabetes, recommendations cannot be made for most therapeutic approaches to CAN.

Original languageEnglish
Pages (from-to)639-653
Number of pages15
JournalDiabetes/Metabolism Research and Reviews
Volume27
Issue number7
DOIs
Publication statusPublished - Oct 2011

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Orthostatic Hypotension
Morbidity
Mortality
Diabetic Neuropathies
Diabetic Nephropathies
Diabetes Complications
Dyslipidemias
Type 1 Diabetes Mellitus
Tachycardia
Type 2 Diabetes Mellitus
Cost-Benefit Analysis
Epidemiology
Obesity
Heart Rate
Guidelines
Hypertension
Therapeutics

Keywords

  • Cardiovascular
  • Diabetic autonomic neuropathy
  • Diagnosis
  • Epidemiology
  • Prognosis
  • Treatment

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Medicine(all)

Cite this

Spallone, V., Ziegler, D., Freeman, R., Bernardi, L., Frontoni, S., Pop-Busui, R., ... Valensi, P. (2011). Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management. Diabetes/Metabolism Research and Reviews, 27(7), 639-653. https://doi.org/10.1002/dmrr.1239

Cardiovascular autonomic neuropathy in diabetes : Clinical impact, assessment, diagnosis, and management. / Spallone, Vincenza; Ziegler, Dan; Freeman, Roy; Bernardi, Luciano; Frontoni, Simona; Pop-Busui, Rodica; Stevens, Martin; Kempler, P.; Hilsted, Jannik; Tesfaye, Solomon; Low, Phillip; Valensi, Paul.

In: Diabetes/Metabolism Research and Reviews, Vol. 27, No. 7, 10.2011, p. 639-653.

Research output: Contribution to journalArticle

Spallone, V, Ziegler, D, Freeman, R, Bernardi, L, Frontoni, S, Pop-Busui, R, Stevens, M, Kempler, P, Hilsted, J, Tesfaye, S, Low, P & Valensi, P 2011, 'Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management', Diabetes/Metabolism Research and Reviews, vol. 27, no. 7, pp. 639-653. https://doi.org/10.1002/dmrr.1239
Spallone, Vincenza ; Ziegler, Dan ; Freeman, Roy ; Bernardi, Luciano ; Frontoni, Simona ; Pop-Busui, Rodica ; Stevens, Martin ; Kempler, P. ; Hilsted, Jannik ; Tesfaye, Solomon ; Low, Phillip ; Valensi, Paul. / Cardiovascular autonomic neuropathy in diabetes : Clinical impact, assessment, diagnosis, and management. In: Diabetes/Metabolism Research and Reviews. 2011 ; Vol. 27, No. 7. pp. 639-653.
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