THE NATURAL PROGRESSION OF AUTONOMIC NEUROPATHY AND AUTONOMIC FUNCTION-TESTS IN A COHORT OF PEOPLE WITH IDDM

OBJECTIVE - To test the natural progression of symptoms oi autonomic n europathy (AN) and function tests in subjects with IDDM. RESEARCH DESI GN AND METHODS - Seventy-six subjects with IDDM of <10 years duration had cardiovascular autonomic reflex tests and were evaluated for signs and symptoms of AN. RESULTS - Fifty-seven subjects (66%) were availab le for restudy 9 years later (15 had died, 4 could not be located). Of the symptoms of AN, only gastroparesis increased in prevalence (P < 0 .01). Of the five cardiovascular AN measures, only the R-R response to the Valsalva maneuver deteriorated (F[1,44] = 10.61, P < 0.01). CONCL USIONS - The progression of AN in IDDM is monitored best longitudinall y by the Valsalva maneuver because of the small variance ratio in repe ated measures. Prevalence rates can be monitored by expiration-to-insp iration R-R or Valsalva ratios. Most clinical signs and symptoms of AN do not progress, underscoring the need for objective and quantitative autonomic function tests to identify people at risk for premature dea th.