Autonomic neuropathic symptoms in patients with diabetes: practical tools for screening in daily routine

BackgroundDiabetic autonomic neuropathy (DAN) is a frequent complication in people with diabetes whose screening is often neglected. This study aimed to evaluate DAN through practical tools in people with diabetes in a referral center for diabetes treatment.MethodsDAN symptoms and severity were assessed using the Survey of Autonomic Symptoms (SAS) via digital application (app) in patients attended from June 1, 2021, to November 12, 2021. SAS scoring for DAN was performed using established validated cutoffs. The adhesive with cobalt salt color indicator (Neuropad (TM)) was used as a measure of sudomotor dysfunction. Demographical and clinical data were also collected.ResultsData from 109 participants, 66.9% T2DM, 73.4% female, with a median age of 54.00 (+/- 20.00) years, were analyzed. Symptomatic DAN was present in 69.7% of participants and was associated with older age (p = 0.002), higher HbA1c (p = 0.043), higher abdominal circumference (p = 0.019), higher BMI (p = 0.013), more likely to have metabolic syndrome (MS) with a 10-fold increased risk, and more frequent association with diabetic peripheral neuropathy (p = 0.005). Sudomotor dysfunction was found in 65 participants with positive Neuropad (TM) detected in 63.1% of them.ConclusionThe use of SAS through an app proved to be a practical and easy-to-use instrument to document symptoms of DAN in busy clinical practice. The high frequency of symptoms draws attention to the importance of screening this underdiagnosed diabetes complication. The risk factors and comorbidities associated with symptomatic DAN highlight the patients' phenotypes linked to MS that should be targeted for DAN evaluations in larger samples in the community.

Automated summary

This study aimed to evaluate diabetic autonomic neuropathy (DAN) in people with diabetes using practical tools. The results showed a high frequency of symptomatic DAN, which was associated with factors such as age, blood sugar, and abdominal circumference. Using a digital app to assess DAN symptoms proved to be a practical and easy-to-use method, and there is a need to assess metabolic syndrome in larger samples for DAN evaluations.