Autonomic Neuropathy Is Treatable
Autonomic Neuropathy Is Treatable
Published: April 2009
Cardiovascular autonomic neuropathy (CAN) is associated with high risk of sudden cardiac death. In patients with diabetes, diabetic autonomic neuropathy (DAN) indicates an increased incidence of CAN, and is diagnosed based on the early symptoms of neuropathy and autonomic dysfunction. These symptoms may include orthostatic dizziness, gastrointestinal (GI) and genito-urinary (GU) symptoms, and hypoglycemia unawareness or unresponsiveness. In general, a diagnosis of DAN is made only after eliminating other causes of neuropathy. DAN and CAN are preceded by autonomic dysfunction (see Figure 1), a progression of factors not limited to diabetes. The process of aging causes autonomic decline, which in turn leads to autonomic neuropathy. Chronic diseases such as diabetes accelerate the aging process and can cause early onset of autonomic neuropathy. Among individuals who do not have diabetes, the condition of DAN can be referred to as ‘advanced autonomic dysfunction.’
Regardless of what the condition is called, and contrary to the common misperception, autonomic dysfunction is treatable. However, the earlier the autonomic dysfunction is detected, the greater the number of therapy options (see Table 1). Therefore, DAN or advanced autonomic dysfunction may be more difficult to treat. In other words, it is easier to correct earlystage autonomic dysfunction compared with advanced-stage autonomic neuropathic damage.
The main function of the autonomic nervous system (ANS) is to maintain homeostasis, regardless of the conditions. The two main branches of the ANS, the parasympathetic and the sympathetic, can dynamically adjust their input to maintain homeostasis and apparent normalcy even in the face of degraded end-organ function. Often these ANS adjustments result in autonomic imbalance and begin to affect other systems within the body, including the cardiovascular system. This is, in part, the basis for the constellation of symptoms known to degrade quality of life in many chronic diseases. By the time symptoms present as a result of end-organ dysfunction or failure, the ANS has been out of balance for considerably longer.
- Vinik AI, Ziegler D, Circulation, 2007;115:387–97.
- Vinik AI, et al., US Endocrine Disease, 2007;2:2–9.
- Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology, Circulation, 1996;93:1043–65.
- Boulton AJM,et al., Diabetes Care, 2005;28:956–62.
- Grundy SM, et al., Circulation, 1999;100:1134–46.
- Low P, and the Therapeutics and Technology Assessment Subcommittee, Neurology, 1996;46:873–80.
- Aring AM, et al., Am Fam Physicians, 2005;71:2123–30.






