Diabetes-Induced Cardiac Autonomic Neuropathy: Impact on Heart Function and Prognosis

Biomedicines. 2022 Dec 15;10(12):3258. doi: 10.3390/biomedicines10123258.


Cardiovascular autonomic neuropathy (CAN) is a severe complication of the advance stage of diabetes. More than 50% of diabetic patients diagnosed with peripheral neuropathy will have CAN, with clinical manifestations including tachycardia, severe orthostatic hypotension, syncope, and physical exercise intolerance. Since the prevalence of diabetes is increasing, a concomitant increase in CAN is expected and will reduce quality of life and increase mortality. Autonomic dysfunction is associated with reduced baroreflex sensitivity and impairment of sympathetic and parasympathetic modulation. Various autonomic function tests are used to diagnose CAN, a condition without adequate treatment. It is important to consider the control of glucose level and blood pressure as key factors for preventing CAN progression. However, altered biomarkers of inflammatory and endothelial function, increased purinergic receptor expression, and exacerbated oxidative stress lead to possible targets for the treatment of CAN. The present review describes the molecular alterations seen in CAN, diagnosis, and possible alternative treatments.

Keywords: cardiac autonomic neuropathy; diabetes; endothelium dysfunction; inflammation; oxidative stress.

Publication types

  • Review

Grants and funding

This research was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, #309498/2020-1), and Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, #E-26/200.881/2021), and APC was funded by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, #E-26/211.114/2021).