AUTONOMIC NEUROPATHY - CLINICAL AND INSTRUMENTAL FINDINGS

The development of sensitive techniques evaluating functions under aut onomic control has allowed the early detection of widespread abnormali ties in diabetes mellitus. However, despite a high frequency of functi onal abnormalities. an overt clinical syndrome develops slowly and is guile rare. Characteristic clinical features, more recent methods for evaluating autonomic function, diagnostic procedures, and main instrum ental findings in a diabetic population are reported. Emphasis is give n to more promising techniques evaluating autonomic control of the car diovascular system, such as myocardial scintigraphy and assessment of 24-h blood pressure and heart rate variability. The clinical meaning o f the number of functional abnormalities observed in diabetic patients is considered. While the role of autonomic neuropathy in the pathogen esis of gastrointestinal motor disorders, hypoglycaemia unawareness or diabetic impotence needs to be revised, the importance of autonomic-r elated sweating and blood now abnormalities in the pathogenesis of dia betic foot lesions is now better documented. Moreover, growing evidenc e of the importance of autonomic control of cardiovascular system, tog ether with cardiovascular dysfunction linked to diabetic autonomic neu ropathy, supports the hypothesis of a possible role of autonomic neuro pathy in the increased cardiovascular morbidity and mortality observed in diabetic patients. (C) 1997 Wiley-Liss, Inc.