Diabetic Autonomic Neuropathy: Consequences
The correct answers are a (gastroparesis), d (orthostatic hypotension), and e (sweating disorders), as these are all well-established manifestations of diabetic autonomic neuropathy, while hypertension is not a consequence and Charcot arthropathy results from peripheral sensory neuropathy, not autonomic dysfunction. 1
Confirmed Consequences of Diabetic Autonomic Neuropathy
Gastroparesis (Option A - CORRECT)
- Gastroparesis is a major gastrointestinal manifestation of diabetic autonomic neuropathy, presenting with erratic glycemic control and upper gastrointestinal symptoms. 1
- The American Diabetes Association explicitly lists gastroparesis among the major clinical manifestations of diabetic autonomic neuropathy, along with other GI disturbances including esophageal dysmotility, constipation, diarrhea, and fecal incontinence. 1
- Diagnosis requires exclusion of organic causes (peptic ulcer disease, gastric outlet obstruction) via esophagogastroduodenoscopy before specialized testing with gastric emptying scintigraphy. 1
Orthostatic Hypotension (Option D - CORRECT)
- Orthostatic hypotension is a cardinal feature of cardiac autonomic neuropathy (CAN), defined as a fall in systolic blood pressure >20 mmHg or diastolic blood pressure >10 mmHg upon standing without appropriate compensatory heart rate increase. 1
- The American Heart Association recognizes orthostatic hypotension as a significant symptom of autonomic neuropathy that can lead to syncope, near-syncope episodes, and exercise intolerance. 2
- Advanced cardiac autonomic neuropathy presents with orthostatic hypotension and resting tachycardia (>100 bpm), and is independently associated with increased mortality. 1
Sweating Disorders (Option E - CORRECT)
- Sudomotor dysfunction with either increased or decreased sweating is explicitly listed as a major clinical manifestation of diabetic autonomic neuropathy by the American Diabetes Association. 1
- Sudomotor dysfunction presents as dry cracked skin, loss of sweating, and changes in sweat function patterns, which can be among the earliest manifestations of autonomic neuropathy. 2, 3
- These changes contribute to loss of skin integrity, development of fissures and cracks that allow microorganism entry, ultimately leading to ulcers and gangrene. 3
Incorrect Options
Hypertension (Option B - INCORRECT)
- Hypertension is NOT a consequence of diabetic autonomic neuropathy; in fact, the opposite occurs—autonomic neuropathy causes orthostatic hypotension, not hypertension. 1
- While blood pressure control is important in diabetes management to slow retinopathy progression, hypertension itself is not caused by autonomic nerve damage. 1
Charcot Arthropathy (Option C - INCORRECT)
- Charcot arthropathy results from diabetic peripheral neuropathy (sensory and motor nerve damage), not autonomic neuropathy. 1
- This condition develops from loss of protective sensation in the feet, leading to unrecognized trauma and progressive joint destruction—a consequence of sensory nerve dysfunction, not autonomic dysfunction. 1
- Up to 50% of diabetic peripheral neuropathy may be asymptomatic, putting patients at risk for injuries to insensate feet if preventive foot care is not implemented. 1
Additional Key Autonomic Manifestations
Cardiovascular System
- Resting tachycardia, exercise intolerance, silent myocardial ischemia, and hypoglycemia unawareness are all cardiovascular consequences of autonomic neuropathy. 1, 2, 3
- CAN is associated with mortality independently of other cardiovascular risk factors and doubles the relative risk of silent myocardial ischemia. 1, 3
Genitourinary System
- Erectile dysfunction, retrograde ejaculation in men, and female sexual dysfunction (decreased desire, pain during intercourse, inadequate lubrication) are genitourinary manifestations. 1, 2
- Bladder dysfunction presents as urinary incontinence, nocturia, frequent urination, urgency, and weak urinary stream. 1, 2