Understanding Autonomic Neuropathy in Type 2 Diabetes Mellitus – A Prospective Observational Study in Patients Attending Outpatient Clinics of Tertiary Care Hospitals

Diabetic autonomicneuropathy (DAN) is a serious and often underestimated complication of diabetes.Due to its ability to potentially affect any tract of autonomic nervous system,DAN is a systemic-wide disorder, which encompasses a large spectrum of organsand leads to significant increase in morbidity and mortality. Subclinical DANcan occur within a year of diagnosis in T2DM and within 2 years in T1DM, whilefirst symptoms may onset after years.The most common and studied manifestationof DAN is cardiovascular autonomic neuropathy (CAN), owing to itslife-threatening complications (arrhythmias, silent myocardial ischemia, andsudden death) and to its relation with other microangiopathic comorbidities.  Diabetic neuropathy isclassically defined as “the presence of symptoms and/or signs of peripheralnerve dysfunction in people with diabetes after the exclusion of other causesâ€. Sensory, motor, or autonomic nerves can be involved, oftencoexisting.The reported prevalence of DAN varies widely depending on the cohortstudied and the methods of assessment. In randomly selected cohorts ofasymptomatic individuals with diabetes, ∼20% had abnormal cardiovascular autonomic function. DAN frequently coexistswith other peripheral neuropathies and other diabetic complications, but DANmay be isolated, frequently preceding the detection of other complications. DANmay affect many organ systems throughout the body (e.g., gastrointestinal [GI],genitourinary, and cardiovascular). Major clinical manifestations of DANinclude resting tachycardia, exercise intolerance, orthostatic hypotension,constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction,impaired neurovascular function, “brittle diabetes,†and hypoglycemic autonomicfailure.

However, studiesprobing autonomic neuropathy dysfunctions in diabetic patients in Indianscenario are scare. Addressing this dearth, the present prospectiveobservational study has been planned to understand autonomic neurodeficit in acohort of type 2 diabetes mellitus (T2DM) patients attending the outpatientdepartment of a tertiary care hospital.