The Natural Progression of Autonomic Neuropathy and Autonomic Function Tests in a Cohort of People With IDDM

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Abstract
OBJECTIVE To test the natural progression of symptoms of autonomic neuropathy (AN) and function tests in subjects with IDDM. RESEARCH DESIGN AND METHODS Seventy-six subjects with IDDM of < 10 years duration had cardiovascular autonomic reflex tests and were evaluated for signs and symptoms of AN. RESULTS Fifty-seven subjects (66%) were available for restudy 9 years later (15 had died, 4 could not be located). Of the symptoms of AN, only gastroparesis increased in prevalence (P < 0.01). Of the five cardiovascular AN measures, only the R-R response to the Valsalva maneuver deteriorated (F[1,44] = 10.61, P < 0.01). CONCLUSIONS The progression of AN in IDDM is monitored best longitudinally by the Valsalva maneuver because of the small variance ratio in repeated measures. Prevalence rates can be monitored by expiration-to-inspiration R-R or Valsalva ratios. Most clinical signs and symptoms of AN do not progress, underscoring the need for objective and quantitative autonomic function tests to identify people at risk for premature death.