Diabetic Cardiac Autonomic Neuropathy

  • Viktoria Serhiyenko
  • Alexandr Serhiyenko


Cardiac autonomic neuropathy (CAN) is a serious and common complication of diabetes mellitus (DM). Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of CAN has not been fully appreciated. CAN among DM patients is characterized as review of the latest evidence and own data regarding the epidemiology, pathogenesis, clinical signs, diagnosis of CAN, and treatment and the treatment perspectives for diabetic CAN. Lifestyle modification and intensive glycemic control might prevent development or progression of CAN. Pathogenetic treatment of CAN includes: optimization of glycemic control; balanced diet and physical activity; treatment of dyslipoproteinemia; correction of metabolic abnormalities in myocardium; prevention and treatment of thrombosis; use of aldose reductase inhibitors; angiotensin-converting enzyme inhibitors, prostaglandin analogs, acetyl-L-carnitine, antioxidants, first of all α-lipoic acid, use of ω-3 polyunsaturated fatty acids, vasodilators, fat-soluble vitamin B1, aminoguanidine; substitutive therapy of growth factors, in severe cases - treatment of orthostatic hypotension.

The following chapter includes the epidemiology, pathogenesis, clinical impact, assessment, diagnosis and staging, diagnostic criteria, and approaches to prevention and treatment of CAN.


Diabetes mellitus Cardiac autonomic neuropathy Heart rate variability Cardiovascular reflex tests Orthostatic hypotension Treatment 



Ambulatory blood pressure monitoring


Blood pressure


Baroreflex sensitivity


Coronary artery disease


Cardiovascular autonomic neuropathy


Cardiovascular autonomic reflex tests


Coronary heart disease


Cardiovascular diseases




Diabetes mellitus


Heart rate


Heart rate turbulence


Heart rate variability


Left ventricular


Myocardial infarction


Muscle sympathetic nerve activity


Orthostatic hypotension


QT interval


Silent myocardial ischemia


Type 1 diabetes mellitus


Type 2 diabetes mellitus


α-lipoic acid

ω-3 PUFA

ω-3 Polyunsaturated fatty acids



Cardiac autonomic neuropathy

chronic complication of diabetes mellitus, is defined as the impairment of autonomic control of the cardiovascular system in the setting of diabetes after exclusion of other causes and is usually documented by using several cardiovascular autonomic reflex tests.

Cardiovascular autonomic reflex tests

these tests are considered the gold standard in autonomic testing. Heart rate variations during deep breathing, Valsalva maneuver, and lying-to-standing (HR tests) are indices mainly of parasympathetic function, whereas the orthostatic hypotension, the blood pressure response to a Valsalva maneuver, and sustained isometric muscular strain provide indices of sympathetic function.

Orthostatic hypotension

is defined as a fall in BP (i.e., >20 mmHg or more stringent criteria is >30 mmHg for systolic or >10 mmHg for diastolic BP) in response to postural change, from supine to standing.

Non-dipping status

a fall in average sleeping blood pressure < 10% from baseline.

Reverse dipping

nocturnal hypertension.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Viktoria Serhiyenko
    • 1
  • Alexandr Serhiyenko
    • 1
  1. 1.Ostrozskogo str. Department of EndocrinologyLviv National Medical University named after Danylo GalytskiyLvivUkraine

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