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Semin Neurol 2003; 23(4): 365-372
DOI: 10.1055/s-2004-817720
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Diabetic Autonomic Neuropathy

Aaron I. Vinik1 , Roy Freeman2 , Tomris Erbas1
  • 1Strelitz Diabetes Research Institutes, Eastern Virginia Medical School, Norfolk, Virginia
  • 2Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Publication History

Publication Date:
15 April 2004 (online)

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ABSTRACT

Diabetic autonomic neuropathy is the most common and troublesome complication of diabetes mellitus. Although involvement of the autonomic nervous system is generally diffuse, symptoms may be confined to a single target organ or organ system. Complications of diabetic autonomic neuropathy contribute greatly to the morbidity, mortality, and reduced quality of life of the person with diabetes and are the major source of increased costs of caring for the diabetic patient. Factors in the pathogenesis of these complications are altered metabolism, vascular insufficiency, loss of growth factor trophism, and autoimmune destruction of nerves in a visceral and cutaneous distribution. The clinical manifestations and the complications of diabetic autonomic neuropathy are reviewed. Future therapeutic strategies that are developed from a better understanding of the pathogenetic processes underlying this disorder can be directed at the cause rather than the manifestations. There are studies in progress that suggest that autonomic nerves can be induced to regenerate, and the future for patients with diabetic autonomic neuropathy is brighter.

KEYWORDS

Diabetes mellitus - autonomic neuropathy - cardiovascular autonomic neuropathy - gastrointestinal autonomic neuropathy - erectile dysfunction - neurogenic bladder

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