DIVERGENT DEVELOPMENT OF AUTONOMIC AND PERIPHERAL SOMATIC NEUROPATHIES IN NIDDM

There is no information on the mutual occurrence and the development o f autonomic and peripheral somatic neuropathies based on long-term fol low-up of patients with non-insulin-dependent diabetes mellitus (NIDDM ). We investigated the relation between the changes in autonomic funct ion values and electrodiagnostic values, and the relation between the occurrence of autonomic neuropathy and peripheral somatic polyneuropat hy in a group of patients with newly diagnosed NIDDM (n = 133, aged 45 -65 years) at baseline and 5 and 10 years later. Parasympathetic auton omic neuropathy was diagnosed on the basis of heart rate variability d uring deep-breathing and sympathetic autonomic neuropathy on the basis of fall in systolic blood pressure while changing from supine to stan ding. Polyneuropathy was diagnosed on the basis of both clinical crite ria and electrodiagnostic studies (nerve conduction velocity and respo nse-amplitude values), In 10 years 36 patients died, mainly from cardi ovascular causes. Altogether 78 patients completed the study. At 10 ye ars, parasympathetic autonomic neuropathy was diagnosed in 61.3 % of t hose with polyneuropathy and 66.7 % of those without. Likewise, the fr equency of sympathetic autonomic neuropathy was similar in those with polyneuropathy (21.9%) and those without (26.5 %). The respective figu res for combined (both parasympathetic and sympathetic) autonomic neur opathy were 10.0 % and 18.8 %. The worsening of parasympathetic and sy mpathetic autonomic function values was not related to the worsening i n electrodiagnostic results with time. In conclusion, the development of autonomic and peripheral somatic neuropathies was divergent in pati ents with NIDDM suggesting different pathophysiological processes for these neuropathies.