AUTONOMIC NERVOUS FUNCTION IN ELDERLY PATIENTS WITH DIABETES-MELLITUS

Autonomic neuropathy, a risk factor for cardiovascular sudden death, is a recognised complication of Type I and Type II diabetes mellitus in young and middle aged patients. The prevalence of autonomic neuropathy in elderly diabetic patients is not well established. We have studied 20 outpatients with diabetes mellitus (duration 6 months to 40 years) aged 73 (range 67-81 years), compared to 19 healthy non-diabetics aged 74 (69-83 years). Glycosylated haemoglobin was 9.3 +/- 2.1% (mean + sem) in the diabetic patients and 7.0 +/- 0.8% in the non-diabetic subjects (p < 0.001). Heart rate and blood pressure responses to standing, isometric hand grip, ice-cold pressor, deep breathing and Valsalva manoeuvre were recorded as measures of vagally mediated heart rate and variability and sympathetic vasoconstrictor function. There was no significant difference in sympathetic or parasympathetic nervous function between elderly patients with diabetes mellitus compared to healthy age and sex matched controls. It is unlikely that modest impairment of glycaemic control has a clinically important effect on autonomic function in the elderly.