Diabetic autonomic neuropathy: an oft neglected entity

Chinmay S Marathe, Michael Horowitz



Autonomic neuropathy is a common complication of diabetesthat can manifest in a range of different organ systems. It represents a major source of morbidity, mortality and healthcare use.

Key Points

  • Diabetic autonomic neuropathy (DAN) is common and important but generally under-recognised.
  • DAN is not a single entity, but an ‘umbrella term’ with broad clinical implications reflecting the diffuse and integral involvement of the autonomic nervous system with major body organ systems.
  • Cardiac autonomic neuropathy is a particularly serious manifestation that may be associated with silent myocardial infarction and represents a major risk for cardiovascular (CV) mortality.
  • Simple inexpensive tests of cardiac autonomic function are markedly underused.
  • Gastric autonomic neuropathy is not only associated with upper gastrointestinal symptoms but also has impacts on postprandial blood glucose control.
  • Erectile dysfunction, another manifestation of autonomic neuropathy, is common in men with diabetes and a marker of disordered CV function.

    Picture credit: © Science Source/Anatomical Travalogue/