Autonomic symptoms and diabetic neuropathy: a population-based study.

Full Abstract

OBJECTIVE: The prevalence of autonomic symptoms and deficits in certain systems is known, but a comprehensive autonomic symptom profile in diabetes is not available. We aimed to estimate this using a laboratory evaluation of autonomic function and a validated self-report measure of autonomic symptoms in patients and matched control subjects from the population-based Rochester Diabetic Neuropathy Study. RESEARCH DESIGN AND METHODS: Participants included 231 patients with diabetes (type 1, n=83; type 2, n=148) and 245 healthy age-matched control subjects. We assessed symptoms using a validated self-report instrument (Autonomic Symptom Profile) and evaluated the severity and distribution of autonomic deficits (cardiovagal, sudomotor, adrenergic) with the objective, laboratory-based Composite Autonomic Severity Score (CASS). RESULTS: Autonomic symptoms were present more commonly in type 1 than in type 2 diabetes, with symptoms of orthostatic intolerance, secretomotor, urinary control, diarrhea, and sleep disturbance and pupillomotor, vasomotor, and erectile dysfunction significantly increased over healthy control subjects in type 2 diabetic patients. The prevalence of autonomic impairment was 54% in type 1 and 73% in type 2 diabetic patients. Severity of autonomic failure was mild overall (mean CASS 2.3; maximum 10), with orthostatic hypotension occurring in 8.4 and 7.4% of type 1 and 2 diabetic patients, respectively. Fourteen percent of patients had a CASS > or =5, indicating moderate to severe generalized autonomic failure. The correlation of symptoms with autonomic deficits (CASS) was better in type 1 than type 2 diabetic subjects and was weak overall. CONCLUSIONS: These findings indicate that autonomic symptoms and deficits are common in diabetes, but mild in severity, and that the correlation between symptom scores and deficits is overall weak in mild diabetic neuropathy, emphasizing the need to separately evaluate autonomic symptoms.

Author information

Author/s: Low, Phillip A (PA); Benrud-Larson, Lisa M (LM); Sletten, David M (DM); Opfer-Gehrking, Tonette L (TL); Weigand, Stephen D (SD); O'Brien, Peter C (PC); Suarez, Guillermo A (GA); Dyck, Peter J (PJ);

Affiliation: Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. low(-atsign-)mayo.edu

Grants: HD-07447 (Agency:NICHD NIH HHS) ; MO1 RR00585 (Agency:NCRR NIH HHS) ; NS-32352 (Agency:NINDS NIH HHS) ; NS-39722 (Agency:NINDS NIH HHS) ; NS-43364 (Agency:NINDS NIH HHS) ; NS-44233 (Agency:NINDS NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: Diabetes care (Diabetes Care), published in United States. (Language: eng)

Reference: 2004-Dec; vol 27 (issue 12) : pp 2942-7

Dates: Created 2004/11/24; Completed 2005/04/11; Revised 2007/11/14;

PMID: 15562211, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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