From the Guidelines
The management of diabetes-associated autonomic neuropathy should prioritize optimal glucose control, with a focus on preventing or delaying the development of neuropathy in people with type 1 diabetes and slowing the progression of neuropathy in people with type 2 diabetes, as recommended by the most recent guidelines 1. The foundation of treatment for diabetes-associated autonomic neuropathy involves optimizing glucose management to improve quality of life and reduce the risk of complications.
- Optimal blood glucose control is crucial, with a target HbA1c of less than 7% to prevent progression of neuropathy.
- Additionally, optimizing weight, blood pressure, and serum lipid management can help reduce the risk or slow the progression of diabetic neuropathy, as suggested by recent guidelines 1.
- Assessing and treating pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy is also essential to improve quality of life, with medications such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers recommended as initial pharmacologic treatments for neuropathic pain in diabetes 1.
- Symptom-specific treatments, such as midodrine for orthostatic hypotension and beta-blockers for resting tachycardia, can help manage cardiovascular autonomic neuropathy.
- Lifestyle modifications, including regular physical activity, smoking cessation, and alcohol limitation, should complement pharmacological approaches to manage diabetes-associated autonomic neuropathy, as supported by previous studies 1.
From the Research
Management of Diabetes-Associated Autonomic Neuropathy
The management of diabetes-associated autonomic neuropathy (DAN) is a complex process that involves a multifaceted approach. Some key aspects of management include:
- Strict glycemic control with intensive insulin treatment, multifactorial intervention, and lifestyle modification, including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise 2
- Early detection and control of diabetes and other cardiovascular risk factors is crucial to treat and prevent progression of autonomic neuropathy 3
- Novel pharmacological approaches, along with endoscopic and surgical treatment options, contribute to improved outcomes in diabetic gastrointestinal autonomic neuropathy 4
- Current management options for gastrointestinal autonomic neuropathy are, for the main part, empirical and sub-optimal, highlighting the need for further research in this area 5
Prevention Strategies
Prevention strategies for DAN are based on:
- Strict glycemic control with intensive insulin treatment 2
- Multifactorial intervention, including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise 2
- Early detection and control of diabetes and other cardiovascular risk factors 3
Treatment-Induced Neuropathy
A new entity of treatment-induced neuropathy (TIND) of diabetes mellitus causing autonomic neuropathy is being increasingly recognized, highlighting the need for careful consideration of treatment options 3
Diagnostic Approaches
Diagnostic approaches for cardiovascular autonomic neuropathy (CAN) include: