PMID- 30793549
OWN - NLM
STAT- MEDLINE
DCOM- 20200410
LR  - 20200410
IS  - 2233-6079 (Print)
IS  - 2233-6087 (Electronic)
IS  - 2233-6079 (Linking)
VI  - 43
IP  - 1
DP  - 2019 Feb
TI  - Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic 
      Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet.
PG  - 3-30
LID - 10.4093/dmj.2018.0259 [doi]
AB  - The burden of diabetic cardiovascular autonomic neuropathy (CAN) is expected to 
      increase due to the diabetes epidemic and its early and widespread appearance. 
      CAN has a definite prognostic role for mortality and cardiovascular morbidity. 
      Putative mechanisms for this are tachycardia, QT interval prolongation, 
      orthostatic hypotension, reverse dipping, and impaired heart rate variability, 
      while emerging mechanisms like inflammation support the pervasiveness of 
      autonomic dysfunction. Efforts to overcome CAN under-diagnosis are on the table: 
      by promoting screening for symptoms and signs; by simplifying cardiovascular 
      reflex tests; and by selecting the candidates for screening. CAN assessment 
      allows for treatment of its manifestations, cardiovascular risk stratification, 
      and tailoring therapeutic targets. Risk factors for CAN are mainly glycaemic 
      control in type 1 diabetes mellitus (T1DM) and, in addition, hypertension, 
      dyslipidaemia, and obesity in type 2 diabetes mellitus (T2DM), while preliminary 
      data regard glycaemic variability, vitamin B12 and D changes, oxidative stress, 
      inflammation, and genetic biomarkers. Glycaemic control prevents CAN in T1DM, 
      whereas multifactorial intervention might be effective in T2DM. Lifestyle 
      intervention improves autonomic function mostly in pre-diabetes. While there is 
      no conclusive evidence for a disease-modifying therapy, treatment of CAN 
      manifestations is available. The modulation of autonomic function by SGLT2i 
      represents a promising research field with possible clinical relevance.
CI  - Copyright (c) 2019 Korean Diabetes Association.
FAU - Spallone, Vincenza
AU  - Spallone V
AUID- ORCID: 0000-0002-8905-216X
AD  - Division of Endocrinology, Department of Systems Medicine, University of Rome Tor 
      Vergata, Rome, Italy. vispa@mclink.it.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Korea (South)
TA  - Diabetes Metab J
JT  - Diabetes & metabolism journal
JID - 101556588
RN  - 0 (Blood Glucose)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
MH  - Autonomic Nervous System/physiopathology
MH  - Autonomic Nervous System Diseases/*complications/therapy
MH  - Blood Glucose/analysis
MH  - Cardiovascular Diseases/diagnosis/epidemiology/mortality
MH  - Cardiovascular System/physiopathology
MH  - Cost of Illness
MH  - Diabetes Mellitus, Type 1/*complications/epidemiology/mortality
MH  - Diabetes Mellitus, Type 2/*complications/epidemiology/mortality
MH  - Diabetic Neuropathies/*diagnosis/epidemiology/therapy
MH  - Dyslipidemias/epidemiology
MH  - Humans
MH  - Hypertension/epidemiology
MH  - Mass Screening/methods
MH  - Obesity/epidemiology
MH  - Prognosis
MH  - Risk Factors
MH  - Risk Reduction Behavior
MH  - Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
PMC - PMC6387879
OTO - NOTNLM
OT  - Autonomic nervous system
OT  - Cardiovascular system
OT  - Diabetic neuropathies
OT  - Diagnosis
OT  - Epidemiology
OT  - Glucagon-like peptide-1 receptor
OT  - Hypotension, orthostatic
OT  - Prognosis
OT  - Sodium-glucose transporter 2 inhibitors
OT  - Therapeutics
COIS- Vincenza Spallone has received research grants from Biocure srl Italy and 
      Boehringer Ingelheim Italy. She has received remunerations for lectures or 
      consultations for AWP srl Italy, Boehringer Ingelheim Italy, Daiichi Sankyo 
      Europe, Ely-Lilly Italy, IRIS Servier France, Laborest Italy, Pfizer Italy, 
      Sanofi Aventis Italy, Schwarz Pharma Europe, Worwag Pharma Germany. She has 
      served on advisory boards for Angelini S.p.A Italy, TRIGOcare International 
      Germany, and Worwag Pharma GmbH & Co Germany.
EDAT- 2019/02/23 06:00
MHDA- 2019/02/23 06:01
PMCR- 2019/02/01
CRDT- 2019/02/23 06:00
PHST- 2019/01/14 00:00 [received]
PHST- 2019/02/01 00:00 [accepted]
PHST- 2019/02/23 06:00 [entrez]
PHST- 2019/02/23 06:00 [pubmed]
PHST- 2019/02/23 06:01 [medline]
PHST- 2019/02/01 00:00 [pmc-release]
AID - 43.3 [pii]
AID - 10.4093/dmj.2018.0259 [doi]
PST - ppublish
SO  - Diabetes Metab J. 2019 Feb;43(1):3-30. doi: 10.4093/dmj.2018.0259.