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The natural history of diabetic autonomic neuropathy.
Q J Med. 1980 Winter; 49(193):95-108.QJ

Abstract

Seventy-three diabetics (62 males and 11 females) who complained of symptoms suggestive of autonomic neuropathy were followed prospectively for up to five years. Thirty patients presented with impotence alone, while the other 43 presented with one or more of the following: postural hypotension, intermittent diarrhoea, hypoglycaemic unawareness, sweating abnormalities and gastric fullness. Most subjects with impotence alone had normal autonomic function tests (responses to the Valsalva manoeuvre and sustained handgrip) whereas the majority with other symptoms had abnormal tests. Twenty-six subjects (20 males and six females) died during the follow-up period. Of the 33 with initially normal autonomic function tests, five (15 per cent) died, whereas of the 40 with initially abnormal tests, 21 (53 per cent) died. Diabetics with symptoms of autonomic neuropathy and abnormal autonomic function tests, had a calculated mortality rate after two-and-a-half years of 44 per cent and after five years of 56 per cent. Half the deaths in those with abnormal tests were from renal failure, and the remainder were either sudden and unexpected, or from other causes which may have been associated with the autonomic neuropathy. Autonomic function testing repeated during the follow-up period showed that some normal tests later became abnormal, but once tests were abnormal, they usually remained abnormal. A number of subjects with impotence alone developed other features of autonomic neuropathy and abnormal tests during the follow up period. Symptoms of autonomic neuropathy, particularly postural hypotension, gastric symptoms and hypoglycaemic unawareness, together with abnormal autonomic function tests, carry a very poor prognosis. Diarrhoea and importence, on their own, cannot be relied on as symptoms of autonomic neuropathy. Autonomic function testing using simple cardiovascular reflexes give a good guide to the prognosis of diabetic autonomic neuropathy.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

7433630

Citation

Ewing, D J., et al. "The Natural History of Diabetic Autonomic Neuropathy." The Quarterly Journal of Medicine, vol. 49, no. 193, 1980, pp. 95-108.
Ewing DJ, Campbell IW, Clarke BF. The natural history of diabetic autonomic neuropathy. Q J Med. 1980;49(193):95-108.
Ewing, D. J., Campbell, I. W., & Clarke, B. F. (1980). The natural history of diabetic autonomic neuropathy. The Quarterly Journal of Medicine, 49(193), 95-108.
Ewing DJ, Campbell IW, Clarke BF. The Natural History of Diabetic Autonomic Neuropathy. Q J Med. 1980;49(193):95-108. PubMed PMID: 7433630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The natural history of diabetic autonomic neuropathy. AU - Ewing,D J, AU - Campbell,I W, AU - Clarke,B F, PY - 1980/1/1/pubmed PY - 1980/1/1/medline PY - 1980/1/1/entrez SP - 95 EP - 108 JF - The Quarterly journal of medicine JO - Q J Med VL - 49 IS - 193 N2 - Seventy-three diabetics (62 males and 11 females) who complained of symptoms suggestive of autonomic neuropathy were followed prospectively for up to five years. Thirty patients presented with impotence alone, while the other 43 presented with one or more of the following: postural hypotension, intermittent diarrhoea, hypoglycaemic unawareness, sweating abnormalities and gastric fullness. Most subjects with impotence alone had normal autonomic function tests (responses to the Valsalva manoeuvre and sustained handgrip) whereas the majority with other symptoms had abnormal tests. Twenty-six subjects (20 males and six females) died during the follow-up period. Of the 33 with initially normal autonomic function tests, five (15 per cent) died, whereas of the 40 with initially abnormal tests, 21 (53 per cent) died. Diabetics with symptoms of autonomic neuropathy and abnormal autonomic function tests, had a calculated mortality rate after two-and-a-half years of 44 per cent and after five years of 56 per cent. Half the deaths in those with abnormal tests were from renal failure, and the remainder were either sudden and unexpected, or from other causes which may have been associated with the autonomic neuropathy. Autonomic function testing repeated during the follow-up period showed that some normal tests later became abnormal, but once tests were abnormal, they usually remained abnormal. A number of subjects with impotence alone developed other features of autonomic neuropathy and abnormal tests during the follow up period. Symptoms of autonomic neuropathy, particularly postural hypotension, gastric symptoms and hypoglycaemic unawareness, together with abnormal autonomic function tests, carry a very poor prognosis. Diarrhoea and importence, on their own, cannot be relied on as symptoms of autonomic neuropathy. Autonomic function testing using simple cardiovascular reflexes give a good guide to the prognosis of diabetic autonomic neuropathy. SN - 0033-5622 UR - https://www.unboundmedicine.com/medline/citation/7433630/The_natural_history_of_diabetic_autonomic_neuropathy_ DB - PRIME DP - Unbound Medicine ER -