Current Diagnosis and Treatment Approaches in Diabetic Autonomic Neuropathy

Year 2017, , 129 - 133, 01.09.2017

Eşref Araç

https://doi.org/10.5505/abantmedj.2017.48658

Abstract

Diabetic autonomic neuropathy is the most common and troublesome complication of diabetes mellitus. Though involvement of the autonomic nervous system is generally diffuse, symptoms may be confined to a single target organ or organ system. Complications of diabetic autonomic neuropathy contribute greatly to the morbidity, mortality, and reduced quality of life of the person with diabetes and are the major source of increased costs of caring for the diabetic patient. Factors in the pathogenesis of these complications are altered metabolism, vascular insufficiency, loss of growth factor trophism, and autoimmune destruction of nerves in a visceral and cutaneous distribution. The clinical manifestations and the complications of diabetic autonomic neuropathy are reviewed. Future therapeutic strategies that are developed from a better understanding of the pathogenetic processes underlying this disorder can be directed at the cause rather than the manifestations. There are studies in progress that suggest that autonomic nerves can be induced to regenerate, and the future for patients with diabetic autonomic neuropathy is brighter.

Keywords

Diabetes, Diabetic Autonomic Neuropathy, diagnosis

Diyabetik Otonom Nöropati' de Güncel Tanı ve Tedavi Yaklaşımları

Abstract

Diyabetik otonom nöropati, diyabetin en sık ve en sıkıntı verici komplikasyonudur. Otonom sinir sistemi OSS tutulumu genellikle diffuz olsa da, semptomlar tek bir hedef organ veya sistem ile sınırlı olabilir.Diyabetik otonom nöropatinin komplikasyonları mortalite ve morbiditede artışa, yaşam kalitesinde azalmaya ve diyabetik hastaların tedavi maliyetinde artışa sebep olmaktadır.Bu komplikasyonların patogenezindeki faktörler; metabolizmada değişme, vasküler yetersizlik, büyüme faktörlerinin trofizminde kayıp ve viseral ve kutanöz sinirlerde otoimmun destriksiyon olarak sıralanabilir. Diyabetik otonom nöropatinin komplikasyonları ve klinik manifestasyonları ile ilgili yayınlar mevcuttur. Gelecekte, hastalığın altında yatan patolojik sürecin daha iyi anlaşılması ile birlikte, tedaviler manifestasyona değil neden yönelik olabilir. Halen sürmekte olan ve otonom sinirlerin rejenerasyonunun indüklenebilir olduğu bir takım çalışmaların varlığı, diyabetik otonom nöropati hastalarının tedavisinde ümit vericidir.

Keywords

Diyabet, Diyabetik Otonomon Nöropati, Tanı

References

• Vinik AI, Erbas T, Pfeifer MA, Feldman EL, Stevens MJ, Russell JW. Diabetic autonomic neuropathy. In: Porte D, Sherwin RS, Baron A, eds. Ellenberg & Rifkin's Diabetes Mellitus. 6th ed. New York: McGraw Hill; 2003:789-804.
• Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553- 1579
• Ziegler D. Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Reviews 1999;7: 300-315.
• Kahn J, Zola B, Juni J, Vinik AI. Decreased exercise heart rate in diabetic subjects with cardiac autonomic neuropathy. Diabetes Care 1986;9:389-394
• Kong MF, Horowitz M, Jones KL, Wishart JM, Harding PE. Natural history of diabetic gastroparesis. Diabetes Care 1999; 22:503-507.
• Lysy J, Israeli E, Goldin E. The prevalence of chronic diarrhea among diabetic patients. Am J Gastroenterol 1999;94: 2165-2170.
• Stansberry KB, Peppard HR, Babyak LM, Popp G, McNitt PM, Vinik AI. Primary nociceptive afferents mediate the blood flow dysfunction in non-glabrous (hairy) skin of type 2 diabetes: a new model for the pathogenesis of microvascular dysfunction. Diabetes Care 1999;22:1549- 1554.
• Vinik AI, Erbas T, Park TS, Pierce KK, Stansberry KB. Methods for evaluation of peripheral neurovascular dysfunction. Diabetes Technol Ther 2001;3:29-50
• Vinik A, Erbas T, Stansberry K. Gastrointestinal, genitourinary, and neurovascular disturbances in diabetes. Diabetes Reviews 1999;7:358-378.
• Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care 2002;25:1458-1463.
• Bradley WE. Diagnosis of urinary bladder dysfunction in diabetes mellitus. Ann Intern Med 1980;92:323-326.
• Shaw JE, Parker R, Hollis S, Gokal R, Boulton AJ. Gustatory sweating in diabetes mellitus. Diabet Med 1996;13:1033- 1037.
• Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. 2001;281:E1115-E1121. Endocrinol Metab
• DCCT Research Group. The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia 1998;41:416-423.
• Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999;353:617-622.
• Ziegler D, Reljanovic M, Mehnert H, Gries FA. Alpha-lipoic acid in the treatment of diabetic polyneuropathy in Germany: current evidence from clinical trials. Exp Clin Endocrinol Diabetes 1999;107:421-430.
• Ebbehoj E, Poulsen PL, Hansen KW, Knudsen ST, Molgaard H, Mogensen CE. Effects on heart rate variability of metoprolol supplementary to on going ACE- inhibitor treatment in type I diabetic patients with abnormal albuminuria. Diabetologia 2002;45:965-975.
• Kontopoulos AG, Athyros VG, Didangelos TP, et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997;20:355-361.
• Malik RA, Williamson S, Abbott C, et al. Effect of angiotensin-converting-enzyme trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998;352:1978-1981.
• Richardson D, Vinik A. Etiology and treatment of erectile failure in diabetes mellitus. Curr Diab Rep 2002;2:501- 509.
• Maleki D, Locke GR III, Camilleri M, et al. Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med 2000;160:2808-2816.
• Erbas T, Varoglu E, Erbas B, Tastekin G, Akalin S. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993;16:1511-1514.
• Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med 1990;322:1028-1031.
• Shaw JE, Abbott CA, Tindle K, Hollis S, Boulton AJ. A randomized controlled trial of topical glycopyrrolate, the first specific treatment for diabetic gustatory sweating. Diabetologia 1997;40:299-301.
• Restivo DA, Lanza S, Patti F, et al. Improvement of diabetic autonomic gustatory sweating by botulinum toxin type A. Neurology 2002;59:1971-1973.