AUTONOMIC NEUROPATHY - DIAGNOSIS AND IMPACT ON HEALTH IN ADOLESCENTS WITH DIABETES

Symptomatic autonomic neuropathy and abnormal cardiovascular autonomic tests are associated with increased mortality due to vascular disease and increased risk of sudden deaths. Intensive therapy in the DCCT ca used a significant risk reduction of developing autonomic nerve abnorm alities at five years only in the Primary Prevention Group (4 vs. 9%). At the Royal Alexandra Hospital for Children, the prevalence of cardi ovascular reflex abnormalities is 28%. Over 5 years, we have found no increase in the rate of single cardiovascular abnormalities and a low rate of persistence. Two or more abnormalities developed in 5%. Repeat ed measures of pupillary function showed a significant increase in abn ormalities and a higher level of persistently abnormal tests. Spectral analysis and 24-hour BP monitoring may detect autonomic dysfunction a t earlier stages but longitudinal studies are not yet available.