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Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management
Open accessAbstract
The Cardiovascular Autonomic Neuropathy (CAN) Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy worked to update CAN guidelines, with regard to epidemiology, clinical impact, diagnosis, usefulness of CAN testing, and management. CAN is the impairment of cardiovascular autonomic control in the setting of diabetes after exclusion of other causes. The prevalence of confirmed CAN is around 20%, and increases up to 65% with age and diabetes duration. Established risk factors for CAN are glycaemic control in type 1 and a combination of hypertension, dyslipidaemia, obesity, and glycaemic control in type 2 diabetes. CAN is a risk marker of mortality and cardiovascular morbidity, and possibly a progression promoter of diabetic nephropathy. Criteria for CAN diagnosis and staging are: (1) one abnormal cardiovagal test result identifies possible or early CAN; (2) at least two abnormal cardiovagal test results are required for definite or confirmed CAN; and (3) the presence of orthostatic hypotension in addition to abnormal heart rate test results identifies severe or advanced CAN. Progressive stages of CAN are associated with increasingly worse prognosis. CAN assessment is relevant in clinical practice for (1) diagnosis of CAN clinical forms, (2) detection and tailored treatment of CAN clinical correlates (e.g. tachycardia, orthostatic hypotension, non‐dipping, QT interval prolongation), (3) risk stratification for diabetic complications and cardiovascular morbidity and mortality, and (4) modulation of targets of diabetes therapy. Evidence on the cost‐effectiveness of CAN testing is lacking. Apart from the preventive role of intensive glycaemic control in type 1 diabetes, recommendations cannot be made for most therapeutic approaches to CAN. Copyright © 2011 John Wiley & Sons, Ltd.
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“Timely detection of CAN may help implementation of tailored interventions to prevent its progression and mitigate the risk of associated complications, including CVD, cardiac arrhythmias, myocardial dysfunction leading to congestive heart failure (CHF), CKD, and all-cause mortality.547,614,617–625”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [622]
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“Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia (277).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [277]
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Cites
Effects of Intensive Glucose Lowering in Type 2 Diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802743 · Cited by 7,888
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., et al. (2013) · Journal of Hypertension · doi:10.1097/01.hjh.0000431740.32696.cc · Cited by 5,655
Intensive versus Conventional Glucose Control in Critically Ill Patients
(2009) · New England Journal of Medicine · doi:10.1056/nejmoa0810625 · Cited by 5,119
Glucose control and vascular complications in veterans with type 2 diabetes
Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P. D., Zieve, F. J., Marks, J., Davis, S. N., Hayward, R., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808431 · Cited by 4,762
Effect of a multifactorial intervention on mortality in type 2 diabetes
Gæde, P., Lund-Andersen, H., Parving, H.-H., & Pedersen, O. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0706245 · Cited by 3,465 · cited 1×
“with microalbuminuria [56].”
Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., et al. (2010) · Diabetes Care · doi:10.2337/dc10-1303 · Cited by 2,690
Self-citationVinik, A. I., Maser, R. E., Mitchell, B. D., & Freeman, R. (2003) · Diabetes Care · doi:10.2337/diacare.26.5.1553 · Cited by 2,044
Self-citationBoulton, A. J. M., Vinik, A. I., Arezzo, J. C., Bril, V., Feldman, E. L., Freeman, R., Malik, R. A., Maser, R. E., Sosenko, J. M., & Ziegler, D. (2005) · Diabetes Care · doi:10.2337/diacare.28.4.956 · Cited by 1,859
Self-citationGuidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary
Rydén, L., Standl, E., Bartnik, M., den Berghe, G. V., Betteridge, J. D., de Boer, M., Cosentino, F., Jönsson, B., Laakso, M., Malmberg, K., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehl260 · Cited by 1,644
The Value of Cardiovascular Autonomic Function Tests: 10 Years Experience in Diabetes
Ewing, D. J., Martyn, C., Young, R. J., & Clarke, B. F. (1985) · Diabetes Care · doi:10.2337/diacare.8.5.491 · Cited by 1,436
Flagged first, then by citations
2 of the 67 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Ziegler D, 1993, Prevalence and clinical correlates of cardiovascular autonomic and peripheral diabetic neuropathy in patients attending diabetes centers, Diabetes Metab, 19, 143
Cited by
Sorted by citations
Items 401–500 of 954
Silva, L., Gentil, P., Seguro, C. S., Teles, G. D. O., Silva, M. S., Zamunér, A. R., Beltrame, T., & Rebelo, A. C. S. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.760292 · Cited by 11
“Moreover, the increase in HRrest implies a state of chronic excitation of several tissues and when combined with hyperglycemia it might activate specific pathways that result in neuronal ischemia and cellular degeneration (28, 29).”
BackgroundSamajdar, S. S., Das, S., Sarkar, S., Mukherjee, S., Pathak, A., Lundborg, C. S., Saha, I., Tripathi, S. K., Pal, J., Chatterjee, N., et al. (2022) · Geriatrics · doi:10.3390/geriatrics7060136 · Cited by 11
“Abnormality in any one of the above-mentioned tests was regarded as cardiac autonomic neuropathy [28,34,35].”
BackgroundLiao, X.-P., Zhu, H.-W., Zeng, F., & Tang, Z. (2015) · Journal of Endocrinological Investigation · doi:10.1007/s40618-015-0291-x · Cited by 11
“In this study, CAN was diagnosed based on at least two abnormal cardiovascular autonomic reflex test results based on short-term HRV tests [6, 19, 20].”
BackgroundMethodTang, Z., Zeng, F., Ye, K., Yu, X., & Zhou, L. (2014) · European journal of medical research · doi:10.1186/2047-783x-19-8 · Cited by 11
“Background Cardiovascular autonomic neuropathy (CAN) is rapidly growing in all populations worldwide [1,2].”
BackgroundResultInfluentialda Matta, M. D. F. B., Traon, A. P., Perez‐Lloret, S., Laporte, C., Berdugo, I., Nasr, N., Hanaire, H. P., & Sénard, J. (2018) · Journal of Diabetes Research · doi:10.1155/2018/5601351 · Cited by 11
Cardiac autonomic neuropathy in nonobese young adults with type 1 diabetes
Kim, H. Y., Jung, H. W., Lee, Y. A., Shin, C. H., & Yang, S. W. (2019) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2019.24.3.180 · Cited by 11
Pafili, K., Trypsianis, G. A., Papazoglou, D., Maltezos, E. S., & Παπάνας, Ν. (2020) · Diabetes Therapy · doi:10.1007/s13300-020-00795-0 · Cited by 13
“In addition, patients with proliferative retinopathy were excluded from the Valsalva examination [2].”
BackgroundMethodInfluentialKempler, M., Hajdú, N., Putz, Z., Istenes, I., Vági, O. E., Békeffy, M. Z., Schnabel, K. K., Kempler, P., & Körei, A. E. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103322 · Cited by 13
Self-citationChe, L., Zhang, Y., Yu, J., Xu, L., & Huang, Y. (2021) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000005380 · Cited by 11
Tesfaye, S. H. (2018) · Medicine · doi:10.1016/j.mpmed.2018.11.009 · Cited by 12
Self-citationCardiovascular Autonomic Neuropathy
McCarty, N., & Silverman, B. D. (2016) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2016.11929397 · Cited by 11
“Diab Vasc Dis Res 2008; 5 (4):336– 344.”
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2023) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-023-01024-x · Cited by 10
The Effect of Surgical Weight Loss on Cognition in Individuals with Class II/III Obesity
Reynolds, E. L., Votruba, K., Watanabe, M., Banerjee, M., Elafros, M. A., Chant, E., Villegas‐Umana, E., Giordani, B., Feldman, E. L., & Callaghan, B. C. (2023) · The journal of nutrition health & aging · doi:10.1007/s12603-023-2047-1 · Cited by 11
“Cardiovascular autonomic neuropathy (CAN) was evaluated using the expiration/ inspiration (E/I) ratio, one of the five Ewing cardiovascular reflex tests, that are the gold standard for autonomic testing (15, 16).”
Irlik, K., Aldosari, H., Hendel, M., Kwiendacz, H., Piaśnik, J., Kulpa, J., Ignacy, P., Boczek, S., Herba, M., Kegler, K., et al. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15578 · Cited by 11
Monea, G., Jiritano, R., Salerno, L., Rubino, M., Massimino, M., Perticone, M., Mannino, G. C., Sciacqua, A., Succurro, E., Fiorentino, T. V., et al. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02394-w · Cited by 10
Risi, R., Amendolara, R., Pantano, A. L., Fassino, V., D’Onofrio, L., Coraggio, L., Luverà, D., Masi, D., Watanabe, M., Gnessi, L., et al. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-025-02635-6 · Cited by 10
“To note, current guidelines suggest that a single abnormal result among the two or three heart rate tests represent a sufficient criterion for CAN diagnosis [5].”
InfluentialLu, Y., Tang, Z., Zeng, F., Li, Y., & Zhou, L. (2013) · Diabetology & Metabolic Syndrome · doi:10.1186/1758-5996-5-73 · Cited by 10
“CAN was diagnosed based on at least two abnormal cardiovascular autonomic reflex test results from HRV tests [3].”
BackgroundMethodInfluentialEstévez‐Báez, M., Machado, C., Leisman, G., Brown-Martínez, M., Jas-García, J. D., Montes-Brown, J., Machado, A., & Naranjo, C. C. (2015) · International Journal on Disability and Human Development · doi:10.1515/ijdhd-2015-0014 · Cited by 10
Laursen, J. C., Hansen, C. S., Bordino, M., Vistisen, D., Zobel, E. H., Winther, S. A., Groop, P., Frimodt‐Møller, M., Bernardi, L., & Rossing, P. R. (2020) · Diabetic Medicine · doi:10.1111/dme.14315 · Cited by 10
Self-citationYang, D., Yan, J., Deng, H., Yang, X., Luo, S., Zheng, X., Lv, J., Liang, W., Hong, M., Wu, Z., et al. (2020) · Journal of Diabetes Research · doi:10.1155/2020/7419345 · Cited by 10
“On the other hand, abnormal cardiovascular autonomic function characterized by sympathovagal imbalance and subsequent impaired heart rate regulation is closely associated with cardiovascular morbidity and mortality in diabetes [17, 18].”
BackgroundŽnidarič, M., Škrinjar, D., & Kapel, A. (2023) · Biomolecules and Biomedicine · doi:10.17305/bb.2022.8561 · Cited by 10
“detectionof cardiac autonomicneuropathy [73].”
Imam, H., Karmakar, C. K., Khandoker, A. H., Jelinek, H. F., & Palaniswami, M. S. (2016) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2016.7590853 · Cited by 10
“Subclinical CAN patients are characterized as having sympathetic over activation due to early parasympathetic denervation [1, 2].”
BackgroundMetelka, R., Cibičková, Ľ., Gajdová, J., & Krystyník, O. (2017) · Cor et Vasa · doi:10.1016/j.crvasa.2017.05.001 · Cited by 10
Bianchi, L., Porta, C., Rinaldi, A., Gazzaruso, C., Fratino, P., Cata, P. D., Protti, P., Paltro, R., & Bernardi, L. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.06.047 · Cited by 10
Self-citationPafili, K., Trypsianis, G., Papazoglou, D., Maltezos, E. S., & Παπάνας, Ν. (2018) · Current Vascular Pharmacology · doi:10.2174/1570161116666180829120101 · Cited by 10
García‐Pedraza, J. Á., Hernández‐Abreu, O., Morán, A., Carretero, J., García, M., & Villalón, C. M. (2020) · Scientific Reports · doi:10.1038/s41598-020-76298-6 · Cited by 10
Achmad, C., Lim, N. S., Pramudyo, M., Iqbal, M., Karwiky, G., Febrianora, M., & Natalia, N. (2022) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2022.101135 · Cited by 10
A Review on Autonomic Functional Assessment in Diabetic Patients
Rukadikar, C. A., Rukadikar, A. R., & Kishore, S. (2023) · Cureus · doi:10.7759/cureus.34598 · Cited by 10
“CAN is an “impairment of cardiovascular autonomic regulation in individuals with established diabetes after eliminating alternative causes,” according to the CAN Subcommittee of the “Toronto Consensus Panel on Diabetic Neuropathy” [64].”
BackgroundIs there a connection between postprandial hyperglycemia and IGT related sensory nerve dysfunction?
Németh, N., Putz, Z., Istenes, I., Körei, A. E., Vági, O. E., Kempler, M., Gandhi, R. A., Jermendy, G., Tesfaye, S. H., Tabák, Á. G., et al. (2017) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2017.05.001 · Cited by 10
Self-citationSokolovska, J., Stefanovics, J., Gersone, G., Pahirko, L., Valeinis, J., Kalva-Vaivode, S., Rovīte, V., Blumfelds, L., Pīrāgs, V., & Tretjakovs, P. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1079-4711 · Cited by 10
Hsieh, D.-Y., Lai, Y., Huang, C., Chen, Y.-N., Wu, S.-Y., Chiu, W.-C., Cheng, B., Lin, T.-Y., Chiang, H.-C., & Lu, C. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14050491 · Cited by 12
“As a chronic microvascular complication of diabetes, CAN presents with various clinical manifestations and is associated with an increased risk of mortality [38,39,43].”
BackgroundKornum, D. S., Brock, C., Okdahl, T., Bertoli, D., Kufaishi, H., Wegeberg, A., Høyer, K. L., Mark, E. B., Brock, B., Hansen, C. S., et al. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14956 · Cited by 11
“13 Likewise, long-term heart rate variability measurements are widely used, where parasympathetic activity can be differentiated from combined sympathetic and parasympathetic activity.”
InfluentialSerdarova, M. S., Dimova, R. B., Chakarova, N. Y., Grozeva, G. G., Todorova, A., & Tankova, T. I. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108721 · Cited by 9
Normative data on cardiovascular autonomic function in Greenlandic Inuit
Christensen, M. M. B., Hansen, C. S., Fleischer, J., Vistisen, D., Byberg, S., Larsen, T. J., Laursen, J. C., & Jørgensen, M. E. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002121 · Cited by 9
Varley, B. J., Gow, M. L., Cho, Y. H., Benitez‐Aguirre, P., Cusumano, J. M., Pryke, A., Chan, A. K. F., Velayutham, V., Donaghue, K. C., & Craig, M. E. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13393 · Cited by 9
Association of Diabetic Autonomic Neuropathy with Red Blood Cell Aldose Reductase Activity
Gupta, P. K., Verma, N., Bhattacharya, S., Mahdi, A. A., Usman, K., Tiwari, S., & Bhardwaj, K. (2014) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2013.07.021 · Cited by 9
Nocturnal heart rate variation in diabetic and non-diabetic patients with sleep apnea syndrome
Amra, B., Behjati, M., Penzel, T., Fietze, I., Schoebel, C., & Sarrafzadegan, N. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.11.003 · Cited by 10
Casagrande, S. S., Cowie, C. C., Sosenko, J. M., Mizokami‐Stout, K., Boulton, A. J. M., & Pop‐Busui, R. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa055 · Cited by 10
Self-citationAllegra, A., Rizzo, V., Innao, V., Alibrandi, A., Mazzeo, A., Leanza, R., Terranova, C., Gentile, L., Girlanda, P., Alonci, A., et al. (2021) · Archives of Medical Science · doi:10.5114/aoms/114269 · Cited by 9
“Modifications in the peripheral autonomic nervous system are an initial expression of distal small fiber neuropathy [18].”
BackgroundPapachristou, S., Pafili, K., Trypsianis, G. A., Papazoglou, D., Vadikolias, Κ., & Παπάνας, Ν. (2022) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1831-0991 · Cited by 9
“CAN may be diagnosed by assessing symptoms and signs, ambulatory blood pressure monitoring, or the gold-standard cardiovascular reflex tests (CARTs), which are based on heart rate and blood pressure [1].”
BackgroundA Novel Association Between Nondipping and Painful Diabetic Polyneuropathy
D’Amato, C., Morganti, R., Gennaro, F. D., Greco, C., Marfia, G. A., & Spallone, V. (2014) · Diabetes Care · doi:10.2337/dc14-0528 · Cited by 9
Self-citationTemporal trend of autonomic nerve function and HSP27, MIF and PAI-1 in type 1 diabetes
Zimmerman, M., Enes, S. R., Skärstrand, H., Pourhamidi, K., Gottsäter, A., Wollmer, P., Rolandsson, O., Westergren‐Thorsson, G., & Dahlin, L. B. (2017) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2017.03.001 · Cited by 9
“MIF is also associated with an increased risk of cardiovascular events in patients with coronary artery disease and T2D [18].”
BackgroundInfluentialJelinek, H. F., Adam, M. T. P., Krones, R., & Cornforth, D. J. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817703670 · Cited by 9
Armstrong, K., Gokal, R., Durant, J., Todorsky, T., Chevalier, A., & Fashong, B. (2017) · Medical Acupuncture · doi:10.1089/acu.2017.1214 · Cited by 9
Lai, Y., Lin, Y.-J., Shih, F.-Y., Wang, H., Tsai, N., Kung, C., Lin, W.-C., Cheng, B., Su, Y., Chang, Y., et al. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.10.076 · Cited by 9
Analysis of a Screening System for Diabetic Cardiovascular Autonomic Neuropathy in China
Xue, Y., Lv, Y., Tang, Z., & Dong, J. (2017) · Medical Science Monitor · doi:10.12659/msm.905240 · Cited by 9
Tsubokawa, M., Nishimura, M., Tamada, Y., & Nakaji, S. (2022) · Healthcare · doi:10.3390/healthcare10050793 · Cited by 9
“Autonomic nervous system dysfunction is a known complication of diabetes mellitus [3,4], leading to diabetic autonomic neuropathies, including tachycardia at rest, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, hypoglycemia unawareness, and disordered perspiration [5].”
BackgroundZelenina, T. A., Салухов, В. В., Ab, Z., Zheleznyak, S. G., & Клиценко, О. А. (2021) · Diabetes Mellitus · doi:10.14341/dm12372 · Cited by 10
Felício, J. S., de Moraes, L. V., Lemos, G., de Souza, Í. J. A., Vieira, G. C., Silva, L. D. S. D., de Queiroz, N. N. M., Souza, A. C., de Melo, F. T. C., Neto, J. F. A., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-56934-1 · Cited by 10
Slingerland, S. R., Schulz, D. N., van Steenbergen, G. J., Hamad, M. A. S., Kisters, J. M. H., Timmermans, M. J. C., Teeuwen, K., Dekker, L., & van Veghel, D. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02356-2 · Cited by 8
“Results of the additional sensitivity analyses and propensity score matching can be found in Tables 3, 4, 5 and 6 in the Supplementary materials; all analyses led to similar findings.”
ResultJung, C., Cho, Y. Y., Choi, D., Kim, B., Jung, S.-H., Kim, C., & Mok, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-74390-9 · Cited by 9
Özel, H. F., Alpay, Ş., Asker, E., Gültekin, E. S., & Kazdağlı, H. (2025) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2025.109021 · Cited by 10
Alsarhan, A. A., Amawi, K. F., Almazari, I., Hurirah, H. A., & Alkhatib, A. J. (2020) · Analytical Cellular Pathology · doi:10.1155/2020/3906583 · Cited by 8
Atala, Y. B., de Matos, M. R., Corrêa‐Giannella, M. L., Parisi, M. C. R., Zantut‐Wittmann, D. E., Castillo, A. R., & Santos‐Bezerra, D. P. (2021) · Current Diabetes Reviews · doi:10.2174/1573399817666210827130339 · Cited by 8
Cha, S. (2022) · Medicine · doi:10.1097/md.0000000000031511 · Cited by 8
“[19,20] Digital 12-lead ECGs were recorded on the same day using an ECG device (PI-19E; Tenshi Fukuda, Tokyo, Japan).”
Prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus
Karthikeyan, A., Manjunath, P., Latha, A. T., & Sultana, S. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_609_23 · Cited by 10
“A score of 0‑0.5 was regarded as absent CAN, 1‑1.5 as early CAN, and ≥2 as definite CAN [Table 5].”
BackgroundInfluentialGenetic Factors Associated with the Development of Neuropathy in Type 2 Diabetes
Tordai, D. Z., Hajdú, N., Rácz, R., Istenes, I., Békeffy, M. Z., Vági, O. E., Kempler, M., Körei, A. E., Tóbiás, B., Illés, A., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25031815 · Cited by 9
“The blood pressure response to sustained handgrip is no longer considered (Toronto Consensus Panel) as an acceptable clinical test but only as an investigational one [74].”
BackgroundSelf-citationNeuropathy-specific alterations in a Mexican population of diabetic patients
Carbajal-Ramírez, A., García-Macedo, R., Díaz‐García, C. M., Sánchez-Soto, C., Méndez-Padrón, A., Escobedo, J., Cruz, M., & Hiriart, M. (2017) · BMC Neurology · doi:10.1186/s12883-017-0939-6 · Cited by 8
Hjortkjær, H. Ø., Jensen, T. J., Hilsted, J., Corinth, H., Mogensen, U. M., Køber, L., Fuchs, A., Nordestgaard, B. G., & Kofoed, K. F. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.04.027 · Cited by 8
Self-citationFaber, J. O., Eldrup, E., Selmer, C., Pichat, C. S. H., Hecquet, S. K., Watt, T., Kreiner, S., Karpatschof, B., Gyntelberg, F., Ballegaard, S., et al. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.613858 · Cited by 8
Guo, S., Wang, W., Huang, H., Bi, Y., Jin, Y., Li, C., Zhu, D., & Wang, L. (2021) · Acta Diabetologica · doi:10.1007/s00592-021-01744-4 · Cited by 9
Jeyaseeli, A., Ganesan, R., Mathivanan, D., & Prabagaran, A. (2023) · Cureus · doi:10.7759/cureus.42541 · Cited by 8
“CAN is a condition which is characterized by cardiac autonomic nerve dysfunction in patients with type T2DM [5].”
BackgroundShahreyar, M., Muppidi, V., Choudhuri, I., Sra, J. S., Tajik, A. J., & Jahangir, A. (2015) · Expert Review of Cardiovascular Therapy · doi:10.1586/14779072.2015.1059276 · Cited by 8
“%) for secondary prevention of SCD, was described.”
BackgroundInfluentialDirect renin inhibition improves parasympathetic function in diabetes
Maser, R. E., Lenhard, M. J., Kolm, P., & Edwards, D. G. (2012) · Diabetes Obesity and Metabolism · doi:10.1111/j.1463-1326.2012.01669.x · Cited by 8
“Cardiovascular autonomic neuropathy (CAN), impairment of autonomic control of the cardiovascular system, is prevalent in approximately 20% of individuals with diabetes, but prevalence rates up to 65% have been reported with increased age and duration of diabetes [1].”
BackgroundMethodRiguetto, C. M., Takano, C. R., Admoni, S. N., Parisi, M. C. R., Corrêa‐Giannella, M. L., Pavin, E. J., & Neto, A. M. (2019) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-019-00467-2 · Cited by 8
Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes?
Rogowicz‐Frontczak, A., Falkowski, B., Grzelka‐Woźniak, A., Uruska, A. A., Araszkiewicz, A., & Zozulińska‐Ziółkiewicz, D. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01171-x · Cited by 8
Akinlade, O. M., Owoyele, B. V., & Soladoye, O. A. (2021) · Journal of Basic and Clinical Physiology and Pharmacology · doi:10.1515/jbcpp-2020-0282 · Cited by 8
Laursen, J. C., Rasmussen, I. K. B., Zobel, E. H., Hasbak, P., von Scholten, B. J., Holmvang, L., Ripa, R. S., Hansen, C. S., Frimodt‐Møller, M., Kjær, A., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.780679 · Cited by 8
Diabetes and the Nervous System
Vinik, A. I., CASELLINI, C. M., & Neumann, S. A. (2020) · Endocrinology · doi:10.1007/978-3-030-36694-0_10 · Cited by 9
Zimmerman, M., Pourhamidi, K., Rolandsson, O., & Dahlin, L. B. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00154 · Cited by 8
Valensi, P. E., & Jambart, S. (2024) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/10742484241258381 · Cited by 7
“10 Sympathetic activity was clearly shown to be enhanced in patients with diabetes 17 and in obese patients with hypertension.”
Self-citationCardiovascular autonomic and peripheral sensory neuropathy in women with obesity
Keller, N., Zádori, J., Lippai, B., Szöllősi, D., Márton, V., Wellinger, K., Lada, S., Szűcs, M., Menyhárt, A., Kempler, P., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1386147 · Cited by 8
Self-citationExhaled carbon monoxide in adolescents with diabetic cardiovascular autonomic neuropathy
Vojtková, J., Ďurdík, P., Michnová, Z., Turčan, T., & Čiljaková, M. (2014) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2013-0401 · Cited by 7
Dave, D., Vyas, K., Coté, G. L., & Erraguntla, M. (2024) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2024.106569 · Cited by 8
Damm, J. A., Dalgas-Madsen, A., Hansen, C. S., Pilgaard, K. A., Pociot, F., Hansen, T. W., & Johannesen, J. (2024) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2024.108873 · Cited by 7
Relationship between diabetes mellitus and heart rate variability in community-dwelling elders
Ribeiro, Í. J. S., Pereira, R., Neto, P. D. F. V., Freire, I. V., Casotti, C. A., & dos Reis, M. G. (2017) · Medicina · doi:10.1016/j.medici.2017.12.001 · Cited by 7
“injury by the long duration of diabetes mellitus [32,33].”
BackgroundFarrow, F., Fountoulakis, N., Cummins, K., Sharma, A., Mahmood, R., Vas, P. R. J., Thomas, S., & Karalliedde, J. J. (2020) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1158-9130 · Cited by 7
The Adrenergic System in Cardiovascular Metabolism and Aging
Santulli, G. (2015) · Springer eBooks · doi:10.1007/978-3-319-13680-6_6 · Cited by 7
Potočková, V., Malá, Š., Hoskovcová, L., Čapek, V., Nedělka, T., Riedlbauchová, L., Baumgartner, D., Mensová, L., & Mazanec, R. (2022) · Brain and Behavior · doi:10.1002/brb3.2506 · Cited by 7
“Brain and Behavior published byWiley Periodicals LLC have higher rates of mortality and morbidity from diseases, such as stroke, coronary artery disease, and silent myocardial ischemia, than patients with diabetes without CAN (Maser & Lenhard, 2005; Spallone et al., 2011; Vinik et al., 2003).”
BackgroundMethodResultInfluentialGoh, J. K., & Koh, L. (2023) · Diabetology International · doi:10.1007/s13340-023-00629-x · Cited by 7
“40 Hz) or Relative power of HF band in normalised units [33] Low-to-high frequency ratio (LF/HF) No units Ratio of LF to HF power [33] Time-domain measures of HRV Standard deviation of RR intervals (SDRR) ms Standard deviation of the RR intervals including abnormal and false beats [33] Standard deviation of NN interva…”
BackgroundInfluentialVágvölgyi, A., Ábrahám, J. E., Köteles, É. M., Korom, A., Barnai, M., Szűcs, M., Orosz, A., Kempler, P., Menyhárt, A., Nemes, A., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1224353 · Cited by 7
“An early diagnosis of CAN should be established wherever possible since it enables timely implementation of lifestyle and pharmacological interventions aimed at reversing CAN (10, 37).”
BackgroundMethodSelf-citationDysautonomies des neuropathies périphériques
Adams, D., Cauquil, C. A., & Lozeron, P. (2012) · La Presse Médicale · doi:10.1016/j.lpm.2012.05.030 · Cited by 7
“La dysautonomie cardiovasculaire est présente chez 20 % des sujets diabétiques et l’incidence augmente avec l’âge et le type de diabète [4].”
InfluentialBadea, A. R., Nedelcu, L. D., Văleanu, M., & Zdrenghea, D. T. (2014) · Medicine and Pharmacy Reports · doi:10.15386/cjmed-313 · Cited by 7
“The Toronto International Consensus recommends the use of a set of HRV measurements (totaling seven tests) by adding to the CARTs another three tests of analysis in the frequency domain [22-25].”
MethodNeuropatía diabética y pie diabético
Vázquez, F., Mauricio, D., & Julià, J. V. (2016) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2016.09.004 · Cited by 8
Peripheral and Autonomic Neuropathy in Diabetes
Pop‐Busui, R., Boulton, A. J. M., & Sosenko, J. M. (2018) · Cited by 7
Self-citationKantharia, B. K. (2014) · Cardiology · doi:10.1159/000363283 · Cited by 7
D’Ippolito, I., Carlucci, M. A., D’Amato, C., Lauro, D., & Spallone, V. (2024) · Endocrine Practice · doi:10.1016/j.eprac.2024.06.008 · Cited by 5
Self-citationCorneal confocal microscopy identifies early and definite diabetic cardiac autonomic neuropathy
Azmi, S., Ferdousi, M., Kalteniece, A., Petropoulos, I. N., Alam, U., Ponirakis, G., Asghar, O., Marshall, A. G., Boulton, A. J. M., Efron, N., et al. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112172 · Cited by 6
Lee, S. J., Kim, C. H., Jeong, S. J., Yun, J., Won, J. C., Lee, J. H., Park, I. B., Lee, C. W., Kwon, H., & Park, T. S. (2025) · Journal of Korean Medical Science · doi:10.3346/jkms.2025.40.e154 · Cited by 6
“9 DCAN is associated with increased mortality and morbidity from cardiovascular diseases among patients with DM. 10 Spallone et al. 12 reported a prevalence of CAN of 16.6–20%.”
InfluentialFu, X., Liu, Q., Pan, Q., Peng, R., Huang, Z., Guo, X., Tan, M., Li, Q., Jia, L., Li, Y., et al. (2025) · Journal of Translational Internal Medicine · doi:10.1515/jtim-2025-0013 · Cited by 6
“[10,18] During the tests, the participants were instructed to keep quiet and stay awake.”
He, B.-T., Yun, Y., Lin, Q., Liu, X., & Liu, Y.-D. (2025) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2025.118304 · Cited by 7
Okdahl, T., Wegeberg, A., Jensen, M. M., Quist, J. S., & Brock, C. (2025) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-025-01834-1 · Cited by 6
“…influencing CAN, which aligns with a tendency in recent years to look beyond BMI into lipid profile, fat distribution, or obesity-related hormones such as adiponectin and leptin [29], as they may be able to tell us more about the body composition and process involved in neurodegeneration [2, 29].”
Brock, C., Wegeberg, A., Nielsen, T. A., Karout, B., Hellström, P. M., Drewes, A. M., & Vorum, H. (2023) · Translational Vision Science & Technology · doi:10.1167/tvst.12.6.23 · Cited by 6
“Results:When adjusted for hemoglobin A1c, the regional thickness of the retinal nerve fiber layers was (1) positively associated with peripheral nerve conduction velocities of the sensory and motor nerves (all P < 0.”
BackgroundMethodIntensive Glycemic Therapy in Type 2 Diabetes Patients With Cardiac Autonomic Dysfunction
Huang, Y., Xie, P., Zhang, S., Liu, M., Huang, R., Xiong, Z., Zhong, X., Lin, Y., Zhou, Z., Zhang, W., et al. (2023) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2023.03.020 · Cited by 6
Cardiovascular autonomic neuropathy as a cause of fatigue in chronic hypoparathyroidism
Tabacco, G., Naciu, A. M., Cesareo, R., Maggi, D., Pedone, C., Lelli, D., Santonati, A., Bosco, D., Tommaso, A. M. D., Pozzilli, P., et al. (2019) · Endocrine · doi:10.1007/s12020-019-02101-w · Cited by 6
Effects of Guizhi decoction for diabetic cardiac autonomic neuropathy
Chen, J., Cai, J., Wei, M., Zhang, X., Zhong, M., Liu, M., Yu, Y., & Chen, Q. (2020) · Medicine · doi:10.1097/md.0000000000022317 · Cited by 6
Vágvölgyi, A., Maróti, Á., Szűcs, M., Póczik, C., Urbán-Pap, D., Baczkó, I., Nemes, A., Csajbók, É., Sepp, K., Kempler, P., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.719953 · Cited by 8
Self-citationDiabetes mellitus and heart failure — a modern look at the mechanisms of development
Svarovskaya, A. V., & Анатольевна, Г. А. (2022) · Diabetes Mellitus · doi:10.14341/dm12648 · Cited by 6
de Silva, N. L., Athukorala, T., Gamage, J. L., Katulanda, G. W., de Silva, P., Sumanatilleke, M., & Somasundaram, N. P. (2022) · BMC Endocrine Disorders · doi:10.1186/s12902-022-01108-1 · Cited by 25
“Therefore CART has been used as a surrogate marker of pelvic autonomic neuropathy [17].”
MethodPeters, E., Itani, M., Kristensen, A. G., Terkelsen, A. J., Krøigård, T., Tankişi, H., Jensen, T. S., Finnerup, N. B., & Gylfadottir, S. S. (2023) · Journal of the Peripheral Nervous System · doi:10.1111/jns.12580 · Cited by 6
Metadata
- Authors
- Spallone, V., Ziegler, D., Freeman, R., Bernardi, L., Frontoni, S., Pop‐Busui, R., Stevens, M., Kempler, P., Hilsted, J., Tesfaye, S., Low, P., Valensi, P., & Neuropathy, O. B. O. T. T. C. P. O. D.
- Affiliations
- University of Rome Tor Vergata (IT)
- Düsseldorf University Hospital (DE)
- Beth Israel Deaconess Medical Center (US)
- University of Pavia (IT)
- University of Michigan (US)
- University of Birmingham (GB)
- Copenhagen University Hospital (DK)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Mayo Clinic (US)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Spallone, Vincenza
- ORCID
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2011-10
- Volume
- 27
- Issue
- 7
- Pages
- 639-653
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W2086516175
- Cited by
- 957
- References
- 67
- Citations by year
- 2026: 65 · 2025: 67 · 2024: 78 · 2023: 63 · 2022: 71 · 2021: 86 · 2020: 93 · 2019: 62 · 2018: 78 · 2017: 54 · 2016: 61 · 2015: 60 · 2014: 52 · 2013: 34 · 2012: 24
- FWCI
- 37.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- cardiac autonomic neuropathy, diabetes mellitus, orthostatic hypotension, glycemic control, cardiovascular morbidity and mortality, diabetic nephropathy progression, risk stratification, type 1 diabetes, type 2 diabetes
- MeSH terms
- Autonomic Nervous System, Blood Glucose, Cardiovascular Diseases, Diabetic Neuropathies, Humans, Prognosis, Disease Management
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