The DOI matches its Crossref record; 65 of the 67 references it cites were found in a registry or an index.
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
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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
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Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572
Diabetic neuropathy: A position statement by the American Diabetes Association
Pop-Busui, R., Boulton, A. J. M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., Sosenko, J. M., & Ziegler, D. (2017) · Diabetes Care · doi:10.2337/dc16-2042 · Cited by 2,602
Self-citationGarvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., Nadolsky, K., Pessah-Pollack, R., & Plodkowski, R. (2016) · Endocrine Practice · doi:10.4158/ep161365.gl · Cited by 1,914
Basic Mechanisms of Diabetic Heart Disease
Ritchie, R. H., & Abel, E. D. (2020) · Circulation Research · doi:10.1161/circresaha.120.315913 · Cited by 741
5. Lifestyle Management:Standards of Medical Care in Diabetes—2019
American Diabetes Association (2019) · Diabetes Care · doi:10.2337/dc19-s005 · Cited by 700
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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