Autonomic neuropathy in diabetes

Diabetic autonomic neuropathy (DAN) is a serious and often under-recognized complication of diabetes that can affect any division of the autonomic nervous system (ANS), presenting with a wide range of signs and symptoms. The pathophysiology of DAN involves a complex interplay of hyperglycemia-driven metabolic and vascular pathways, oxidative stress, inflammation, and autonomic imbalance, ultimately leading to progressive nerve dysfunction. Cardiovascular autonomic neuropathy (CAN) has emerged as a particularly severe condition, associated with heightened risk of arrhythmia, silent myocardial ischemia, heart failure, and mortality. DAN, however, extends beyond the cardiovascular system, encompassing…