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EnglishThe Cardiovascular Autonomic Neuropathy (CAN) Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy worked to update CAN guidelines, with regard to epidemiology, clinical impact, diagnosis, usefulness of CAN testing, and management. CAN is the impairment of cardiovascular autonomic control in the setting of diabetes after exclusion of other causes. The prevalence of confirmed CAN is around 20%, and increases up to 65% with age and diabetes duration. Established risk factors for CAN are glycaemic control in type 1 and a combination of hypertension, dyslipidaemia, obesity, and glycaemic control in type 2 diabetes. CAN is a risk marker of mortality and cardiovascular morbidity, and possibly a progression promoter of diabetic nephropathy. Criteria for CAN diagnosis and staging are: (1) one abnormal cardiovagal test result identifies possible or early CAN; (2) at least two abnormal cardiovagal test results are required for definite or confirmed CAN; and (3) the presence of orthostatic hypotension in addition to abnormal heart rate test results identifies severe or advanced CAN. Progressive stages of CAN are associated with increasingly worse prognosis. CAN assessment is relevant in clinical practice for (1) diagnosis of CAN clinical forms, (2) detection and tailored treatment of CAN clinical correlates (e.g. tachycardia, orthostatic hypotension, non-dipping, QT interval prolongation), (3) risk stratification for diabetic complications and cardiovascular morbidity and mortality, and (4) modulation of targets of diabetes therapy. Evidence on the cost-effectiveness of CAN testing is lacking. Apart from the preventive role of intensive glycaemic control in type 1 diabetes, recommendations cannot be made for most therapeutic approaches to CAN.
| Tipologia: | Articolo su rivista |
| Citazione: | Spallone, V., Ziegler, D., Freeman, R., Bernardi, L., Frontoni, S., Pop-Busui, R., et al. (2011). Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. DIABETES/METABOLISM RESEARCH AND REVIEWS, 27(7), 639-653. |
| URL: | http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1239/abstract;jsessionid=BD71393877CEE2F09B21B9D5792DC6C2.f04t03 |
| Altre informazioni significative: | Experts in the field of diabetic neuropathy (diabetologists, neurologists, cardiologists, basic researchers and clinical experts) convened to Toronto in 2009, before the annual meeting of the European Diabetic Neuropathy Study Group (Neurodiab) of EASD, for a Consensus Conference to define current knowledge and express recommendations on diabetic neuropathy. This paper includes the report on the cardiovascular autonomic neuropathy. The Toronto consensus guidelines have now become a cornerstone for anyone involved in diabetic neuropathy. |
| IF: | Con Impact Factor ISI |
| Lingua: | English |
| Settore Scientifico Disciplinare: | Settore MED/13 - Endocrinologia |
| Revisione (peer review): | Esperti anonimi |
| Tipo: | Articolo |
| Rilevanza: | Rilevanza internazionale |
| Digital Object Identifier (DOI): | http://dx.doi.org/10.1002/dmrr.1239 |
| Stato di pubblicazione: | Pubblicato |
| Data di pubblicazione: | 6-ott-2011 |
| Titolo: | Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management |
| Autori: | |
| Autori: | Spallone, V; Ziegler, D; Freeman, R; Bernardi, L; Frontoni, S; Pop-Busui, R; Stevens, M; Kempler, P; Hilsted, J; Tesfaye, S; Low, P; Valensi, P |
| Appare nelle tipologie: | 01 - Articolo su rivista |
File in questo prodotto:
| File | Descrizione | Tipologia | Licenza | |
|---|---|---|---|---|
| Spallone V. DMRR2011.Toronto Consensus on Autonomic Diabetic Neuropathy.pdf | Articolo principale | N/A | Copyright dell'editore | Administrator Richiedi una copia |
| SpalloneV.dmrr_1239_sm_supportinginformations_Mat.pdf | Supporting information to main article | N/A | Copyright dell'editore | Administrator Richiedi una copia |
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