Year: 2010
Type: review
Abstract: his review covers the epidemiology, pathophysiology, clinical presentation, and diagnosis of cardiac autonomic neuropathy (CAN) in diabetes and discusses current evidence on approaches to prevention and treatment of CAN.CASE PRESENTATION -A 2 6year-old woman with "brittle" type 1 diabetes and severe CAN experienced sudden cardiac death.She had a 16-year history of poor diabetes control presenting with wide blood glucose fluctuations, recurrent episodes of severe hypoglycemia, and hypoglycemia unawareness.Over time she developed persistent orthostatic hypotension with daily falls in systolic blood pressure ranging from 30 -60 mmHg.These episodes had significant impact on her daily activities and required intermittent therapy with the ␣-1 agonist midodrine.Other complications included severe gastroparesis, refractory diarrhea, and painful diabetic peripheral neuropathy.Her last clinical examination revealed resting tachycardia with a fixed rate of 115 bpm, supine blood pressure of 110/78 mmHg, which dropped to 70/48 mmHg while standing, symmetrical absent pinprick and temperature discrimination in stocking distribution, and left Charcot joint.Her last pertinent laboratory findings were A1C 8.7%, creatinine 1.9 mg/dl, microalbumin/creatinine 496 mg/g, and hemoglobin 10.8 g/dl.•
Source: Diabetes Care
DOI: 10.2337/dc09-1294
Author: Rodica Pop-Busui
Institutions: University of Michigan, Michigan Medicine
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funder: American Diabetes Association
Awards: G4880454274, G8168269335
OpenAlex ID: W1999716853