ABSTRACT
Diabetic autonomic neuropathy is the most common and troublesome complication of diabetes
mellitus. Although involvement of the autonomic nervous system is generally diffuse,
symptoms may be confined to a single target organ or organ system. Complications of
diabetic autonomic neuropathy contribute greatly to the morbidity, mortality, and
reduced quality of life of the person with diabetes and are the major source of increased
costs of caring for the diabetic patient. Factors in the pathogenesis of these complications
are altered metabolism, vascular insufficiency, loss of growth factor trophism, and
autoimmune destruction of nerves in a visceral and cutaneous distribution. The clinical
manifestations and the complications of diabetic autonomic neuropathy are reviewed.
Future therapeutic strategies that are developed from a better understanding of the
pathogenetic processes underlying this disorder can be directed at the cause rather
than the manifestations. There are studies in progress that suggest that autonomic
nerves can be induced to regenerate, and the future for patients with diabetic autonomic
neuropathy is brighter.
KEYWORDS
Diabetes mellitus - autonomic neuropathy - cardiovascular autonomic neuropathy - gastrointestinal
autonomic neuropathy - erectile dysfunction - neurogenic bladder
