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Open Access 09-08-2024 | Diabetes and Cardiac Diseases | Review

Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management

Authors: Aikaterini Eleftheriadou, Vincenza Spallone, Abd A. Tahrani, Uazman Alam

Published in: Diabetologia

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Abstract

Cardiovascular autonomic neuropathy (CAN) is an under-recognised yet highly prevalent microvascular complication of diabetes. CAN affects approximately 20% of people with diabetes, with recent studies highlighting the presence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose), indicating early involvement of the autonomic nervous system. Understanding of the pathophysiology of CAN continues to evolve, with emerging evidence supporting a potential link between lipid metabolites, mitochondrial dysfunction and genetics. Recent advancements, such as streamlining CAN detection through wearable devices and monitoring of heart rate variability, present simplified and cost-effective approaches for early CAN detection. Further research on the optimal use of the extensive data provided by such devices is required. Despite the lack of specific pharmacological interventions targeting the underlying pathophysiology of autonomic neuropathy, several studies have suggested a favourable impact of newer glucose-lowering agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, where there is a wealth of clinical trial data on the prevention of cardiovascular events. This review delves into recent developments in the area of CAN, with emphasis on practical guidance to recognise and manage this underdiagnosed condition, which significantly increases the risk of cardiovascular events and mortality in diabetes.

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Metadata
Title
Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management
Authors
Aikaterini Eleftheriadou
Vincenza Spallone
Abd A. Tahrani
Uazman Alam
Publication date
09-08-2024
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-024-06242-0

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