Diabetic autonomic neuropathy

Diabetic autonomic neuropathy (DAN) is associated with markedly reduced quality of life and increased mortality. DAN can cause multiple symptoms in the cardiovascular system (resting tachycardia, reduced heart rate variability, painless myocardial ischaemia, orthostatic hypotension, exercise intolerance, perioperative instability, sudden death), gastrointestinal tract (oesophageal motor dysfunction, diabetic gastroparesis, gallbladder atony, diarrhoea, constipation, faecal incontinence), genitourinary tract (diabetic cystopathy, sexual dysfunction), and dysfunction in the neuroendocrine, sudomotor, vasomotor, pupillary motor, and respiratory systems. Treatment is causal and symptom-oriented under careful consideration the risks and benefits. Pharmacotherapy primarily includes midodrine for orthostatic hypotension, prokinetic and antiemetic drugs for gastroparesis, antibiotics for diabetic diarrhoea, prucalopride for constipation, and phosphodiesterase 5 inhibitors for erectile dysfunction.