Cardiovascular and Cerebral Dysfunction

  • Sanjeev Kelkar


Nearly 80% of deaths in diabetes are caused by cardiovascular events. Routine management of cardiovascular diseases in diabetes will not suffice. Unless the significance of various abnormalities of cardiovascular disorders is understood, proper treatment will leave many lacunae in care with suboptimal results. This chapter attempts to bring in that understanding, not to scare but to lead to rational understanding. Cerebral vascular or other cerebral disorders with diabetes have received much less attention in general, even among neurologists. This chapter takes a wider view of these disorders, some of which may look unconnected. It is done to alert the clinician about the odd elements which may surface at times and deal with it systematically. After all the clinical acumen should be directed more to such elements while the routine care, guidelines, and protocols are set.


  1. 1.
    Spallone V. Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet. Diabetes Metab J. 2019;43:3–30. Scholar
  2. 2.
    Fisher VL, Tahrani AA. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes Metab Syndr Obes. 2017;10:419–34.CrossRefGoogle Scholar
  3. 3.
    Kempler P, Tesfaye S, Chaturvedi N, Stevens LK, Webb DJ, Eaton S, Kerenyi Z, Tamas G, Ward JD, Fuller JH. Autonomic neuropathy is associated with increased cardiovascular risk factors: the EURODIAB IDDM Complications Study. Diabet Med. 2002;19:900–9. PubMed: 12421426.CrossRefGoogle Scholar
  4. 4.
    Ernsberger U, Rohrer H. Sympathetic tales: sub divisions of the autonomic nervous system and the impact of developmental studies. Neural Dev. 2018;13:20. Scholar
  5. 5.
    Vinik AI, Freeman R, Erbas T. Diabetic autonomic neuropathy. Semin Neurol. 2003;23(4):365–72.CrossRefGoogle Scholar
  6. 6.
    Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes. 2014;5(1):17–39.CrossRefGoogle Scholar
  7. 7.
    Chung T, Prasad K, Lloyd TE. Peripheral neuropathy: clinical and electrophysiological considerations. Neuroimaging Clin N Am. 2014;24(1):49–65.CrossRefGoogle Scholar
  8. 8.
    Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473.CrossRefGoogle Scholar
  9. 9.
    Ninkovic VM, Ninkovic SM, Miloradovic V, et al. Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes. Acta Diabetol. 2016;53(5):737–44.CrossRefGoogle Scholar
  10. 10.
    Tahrani AA, Dubb K, Raymond NT, et al. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia. 2014;57(6):1249–56.CrossRefGoogle Scholar
  11. 11.
    Chung JO, Park SY, Cho DH, Chung DJ, Chung MY. Anemia, bilirubin, and cardiovascular autonomic neuropathy in patients with type 2 diabetes. Medicine (Baltimore). 2017;96(15):e6586.CrossRefGoogle Scholar
  12. 12.
    Oakley I, Emond L. Diabetic cardiac autonomic neuropathy and anesthetic management: review of the literature. AANA J. 2011;79(6):473–9.PubMedGoogle Scholar
  13. 13.
    Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115(3):387–97.CrossRefGoogle Scholar
  14. 14.
    Stevens M, Ali A, Dubb K, Begum S, Piya M, Tahrani A. Obstructive sleep apnea is associated with cardiac autonomic abnormalities in patients with type 2 diabetes. Diabet Med. 2014;31:37. Accessed 21 Sept 2017.
  15. 15.
    Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90(10):5896–903.CrossRefGoogle Scholar
  16. 16.
    Gæde P, Oellgaard J, Carstensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomized trial. Diabetologia. 2016;59(11):2298–307.CrossRefGoogle Scholar
  17. 17.
    Pop-Busui R. What do we know and we do not know about cardiovascular autonomic neuropathy in diabetes. J Cardiovasc Transl Res. 2012;5(4):463–78.CrossRefGoogle Scholar
  18. 18.
    Matta M, Pavy-Le Traon A, Perez-Lloret S, Laporte C, Berdugo I, Nasr N, Hanaire H, Senard JM. Predictors of cardiovascular autonomic neuropathy onset and progression in a cohort of type 1 diabetic patients. J Diabetes Res. 2018;2018:5601351. Scholar
  19. 19.
    Wright EE Jr. Results of the epidemiology of diabetes interventions and complications trial. Clin Diabetes. 2015;33(3):144–5. PMCID: PMC4503938 PMID: 26203207.CrossRefGoogle Scholar
  20. 20.
    Dimova R, Tankova T, Guergueltcheva V, et al. Risk factors for autonomic and somatic nerve dysfunction in different stages of glucose tolerance. J Diabetes Complicat. 2017;31(3):537–43.CrossRefGoogle Scholar
  21. 21.
    Valensi P, Pariès J, Attali JR. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications—the French multicenter study. Metabolism. 2003;52(7):815–20.CrossRefGoogle Scholar
  22. 22.
    Ko SH, Park SA, Cho JH, et al. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care. 2008;31(9):1832–6.CrossRefGoogle Scholar
  23. 23.
    Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, Stevens M, Kempler P, Hilsted J, Tesfay S, Low P, Valensi P. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27:639–53.CrossRefGoogle Scholar
  24. 24.
    Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH. Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology. 1994;80(2):326–37.CrossRefGoogle Scholar
  25. 25.
    Boudina S, Abel ED. Diabetic cardiomyopathy, causes and effects. Rev Endocr Metab Disord. 2010;11(1):31–9.CrossRefGoogle Scholar
  26. 26.
    Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes. 2015;6(1):80–91.CrossRefGoogle Scholar
  27. 27.
    Vinik AI, Erbas T. Diabetic autonomic neuropathy. Handb Clin Neurol. 2013;117:279–94.CrossRefGoogle Scholar
  28. 28.
    Pertaba JL, Merkleyb TL, Cramondc AJ, Cramondc K, Paxtone H, Wue T. Concussion and the autonomic nervous system: an introduction to the field and the results of a systematic review. NeuroRehabilitation. 2018;42:397–427.
  29. 29.
    Greco C, Di Gennaro F, D’Amato C, Morganti R, Corradini D, Sun A, Longo S, Lauro D, Pierangeli G, Cortelli P, Spallone V. Validation of the composite autonomic symptom score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes. Diabet Med. 2017;34:834–8. Scholar

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© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Sanjeev Kelkar
    • 1
  1. 1.Independent Health ResearcherPuneIndia

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