Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy

Spallone, V.; Bellavere, F.; Scionti, L.; Maule, S.; Quadri, R.; Bax, G.; Melga, P.; Viviani, G.L.; Esposito, K.; Morganti, R.; Cortelli, P.; On behalf of the Diabetic Neuropathy Study Group of the Italian Society of Diabetology,

doi:10.1016/j.numecd.2010.07.005

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 21, Issue 1 , Pages 69-78, January 2011

Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy☆

V. Spallone
- Endocrinology, Department of Internal Medicine, Tor Vergata University, via Montpellier, 1, 00133 Rome, Italy
- Corresponding author. Tel./fax: +39 06 20902787.
F. Bellavere
- Villa Salus Hospital, Venezia-Mestre, Italy
L. Scionti
- Department of Internal Medicine, University of Perugia, Perugia, Italy
S. Maule
- Autonomic Unit and Hypertension Unit, Department of Medicine and Experimental Oncology, S. Giovanni Battista Hospital, University of Turin, Turin, Italy
R. Quadri
- S. Vito Hospital, University of Turin, Turin, Italy
G. Bax
- Servizio di Diabetologia e Dietetica, Complesso Socio-Sanitario ai Colli, Padua, Italy
P. Melga
- Department of Endocrine and Metabolic Sciences, University of Genoa, Genoa, Italy
G.L. Viviani
- Department of Internal Medicine, University of Genoa, Genoa, Italy
K. Esposito
- Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy
R. Morganti
- Endocrinology, Department of Internal Medicine, Tor Vergata University, via Montpellier, 1, 00133 Rome, Italy
P. Cortelli
- Department of Neurological Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
On behalf of the Diabetic Neuropathy Study Group of the Italian Society of Diabetology

Received 28 January 2010; received in revised form 2 June 2010; accepted 14 July 2010. published online 19 January 2011.

Abstract

Despite its prevalence, clinical and prognostic impact, diabetic autonomic neuropathy, is widely under-diagnosed. The need for training and expertise to perform the cardiovascular tests (usually the task of diabetologists) is one possible reason. The availability of computer-assisted systems has allowed a wider diffusion of testing, but has also highlighted the need for an adequate knowledge of physiopathological backgrounds for their correct application and interpretation. The recommendations presented here were developed by the Neuropathy Study Group of the Italian Society of Diabetology and then endorsed by the Italian Association for the Study of Neurovegetative System, to promote the widespread adoption of good clinical practice in diabetic cardiovascular autonomic testing by outlining main evidence-based aspects, i.e. which tests, how to perform them, adequate interpretation of the results and their diagnostic use, confounding conditions that can impact on tests reliability. Therefore, these recommendations include the essential aspects of the physiopathological substrate of the tests, the controversial points in their analysis, their diagnostic characteristics, as well as safety. Detailed information is given on the physiological (age, weight, body position, resting heart rate and blood pressure, respiratory pattern, exercise, meals, acute blood glucose changes) and pathophysiological confounding factors, with emphasis on the effects of drugs. Instructions on how to perform the tests and interpret their results are also considered together with indications of candidate patients and periodicity of testing. A patient instruction sheet on why and how to perform the tests is included. Finally, the specific requirements for computerized systems to perform and evaluate cardiovascular tests are provided.

Keywords: Cardiovascular tests, Diagnosis, Diabetic neuropathy, Autonomic testing, Orthostatic hypotension