Autonomic neuropathy predicts mortality in IDDM

Objective. To examine the predictive value of autonomic neuropathy (AN) for mortality. Setting. Groote Schuur Hospital Diabetes Clinic, Cape Town. Design. Cohort study. Subjects. 76 IDDM patients with less than 10 years' duration of diabetes. Methods. At baseline the patients had a clinical examination and assessment of AN using 5 cardiovascular autonomic function tests. After 9 years the p atients were recalled. Results. Al follow-up 57 patients were alive, 4 could not be traced, and 15 had died. There were 13 non-accidental deaths, 7 (54%) due to renal failur e, and 3 unexpected deaths at home. An abnormal response to each autonomic function test was predictive of mortality and there was a significant relat ionship between the severity of AN and mortality. Logistic regression analy sis indicated that AN (odds ratio 2.96, P = 0.006) and nephropathy (odds ra tio 13.15, P = 0.018) at baseline predicted mortality. Conclusion. These data provide further evidence of the significant mortalit y associated with AN and suggest that the risk of mortality increases with increasing severity of AN.