Autonomic Neural Dysfunction in Recently Diagnosed Diabetic Subjects
Abstract
Because onset of autonomic neural dysfunction in the diabetic syndrome has not been well established, sensitive and quantitative measures of autonomic nervous system (ANS) function were made in 19 non-insulin-dependent (NIDD) and 14 insulin-dependent (IDD) recent-onset diabetic subjects. The known duration of diabetes mellitus in the NIDD subjects was ≤ 12 mo. The duration in the IDD subjects was ≤ 24 mo. RR-variation during beta adrenergic blockade (an index of an ANS reflex involving the cardiac parasympathetic nervous system [PNS] pathway) was smaller than that of control subjects in both NIDD (P < 0.001) and IDD subjects (P < 0.01). This PNS abnormality was not likely to be due to volume depletion since acute volume depletion induced by furosemide in six normal subjects (1608 ± 105 ml, mean ± SEM) did not change RR-variation. Dark-adapted pupil size after topical PNS blockade (an index of iris sympathetic nervous system [SNS] activity) was also smaller in both groups of diabetic subjects (NIDD, P < 0.01; IDD, P < 0.05). Pupillary latency time (an index of an ANS reflex involving iris PNS pathway) was prolonged in the NIDD subjects (P < 0.005) but was not significantly altered in the IDD subjects. Thus, it would appear that the ANS is impaired soon after the diagnosis of diabetes mellitus. We hypothesize that early impairment of the ANS is common in IDD and NIDD subjects. This finding is consistent with the hypothesis that abnormal carbohydrate metabolism is an important factor in the etiology of diabetic autonomic neuropathy.
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Diabetic autonomic neuropathy is associated with significant increases in morbidity and mortality, including an increased risk of sudden death.
“diabetic autonomic neuropathy is associated with significant increases in morbidity and mortality, including an increased risk of sudden death (37, 42, 43).”
From Effects of glucagon-like peptide-1, yohimbine, and nitrergic modulation on sympathetic and parasympathetic activity in humans (2008) · cites this paper as [37]
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- Authors
- Pfeifer, M. A., Weinberg, C. R., Cook, D. L., Reenan, A., Halter, J. B., Ensinck, J. W., & Porte, D.
- Affiliations
- United States Department of Veterans Affairs (US)
- Departments of Medicine and Biostatistics, Universities of Washington and Louisville, The Geriatric Research Education and Clinical Center at the Seattle VA Medical Center, and the Louisville and Seattle Veterans Administration Medical Centers
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1984-09-01
- Volume
- 7
- Issue
- 5
- Pages
- 447-453
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2088352152
- Cited by
- 266
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 10 · 2022: 7 · 2021: 3 · 2020: 6 · 2019: 12 · 2018: 5 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 13 · 2013: 15 · 2012: 9
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Keywords
- diabetic autonomic neuropathy, autonomic dysfunction, type 1 diabetes, type 2 diabetes, recent-onset diabetes, heart rate variability, beta-adrenergic blockade, pupil size, furosemide, hypovolemia, carbohydrate metabolism
- MeSH terms
- Adult, Aged, Autonomic Nervous System, Autonomic Nervous System Diseases, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Neuropathies, Electrocardiography, Female, Heart, Humans, Male, Middle Aged, Reflex, Abnormal, Reflex, Pupillary, Vasomotor System
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