Verrotti Alberto, Prezioso Giovanni, Scattoni Raffaella, Chiarelli Francesco
Department of Pediatrics, University of Perugia , Perugia , Italy.
Department of Pediatrics, University of Chieti , Chieti , Italy.
Front Endocrinol (Lausanne). 2014 Dec 1;5:205. doi: 10.3389/fendo.2014.00205. eCollection 2014.
Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes, often overlooked and misdiagnosed. It is a systemic-wide disorder that may be asymptomatic in the early stages. The most studied and clinically important form of DAN is cardiovascular autonomic neuropathy defined as the impairment of autonomic control of the cardiovascular system in patients with diabetes after exclusion of other causes. The reported prevalence of DAN varies widely depending on inconsistent definition, different diagnostic method, different patient cohorts studied. The pathogenesis is still unclear and probably multifactorial. Once DAN becomes clinically evident, no form of therapy has been identified, which can effectively stop or reverse it. Prevention strategies are based on strict glycemic control with intensive insulin treatment, multifactorial intervention, and lifestyle modification including control of hypertension, dyslipidemia, stop smoking, weight loss, and adequate physical exercise. The present review summarizes the latest knowledge regarding clinical presentation, epidemiology, pathogenesis, and management of DAN, with some mention to childhood and adolescent population.
糖尿病自主神经病变（DAN）是糖尿病一种严重且常见的并发症，常被忽视和误诊。它是一种全身性疾病，早期可能无症状。DAN研究最多且临床意义重大的形式是心血管自主神经病变，定义为排除其他病因后糖尿病患者心血管系统自主控制功能受损。DAN的报道患病率因定义不一致、诊断方法不同、研究的患者队列不同而差异很大。其发病机制仍不清楚，可能是多因素的。一旦DAN出现临床症状，尚未发现能有效阻止或逆转它的治疗方法。预防策略基于强化胰岛素治疗严格控制血糖、多因素干预以及生活方式改变，包括控制高血压、血脂异常、戒烟、减肥和进行适当体育锻炼。本综述总结了关于DAN临床表现、流行病学、发病机制和管理的最新知识，并提及了儿童和青少年人群。
