Wu Chaoneng, Devireddy Rakesh, Zazaian Andrew, Kambhatla Sujata, Alzohaili Opada, Saad Chadi
Departments of Internal Medicine.
Cardiology, Garden City Hospital, Michigan State University, Garden City.
Cardiovasc Endocrinol Metab. 2024 Nov 20;13(4):e00319. doi: 10.1097/XCE.0000000000000319. eCollection 2024 Dec.
Diabetic autonomic neuropathy (DAN) and its associated cardiovascular autonomic neuropathy (CAN) can lead to potentially fatal complications. We analyzed two distinct cases of DAN/CAN based on comprehensive cardiovascular autonomic reflex tests (CARTs). Case 1 involves a 27-year-old patient with T1DM suffering from recurrent severe hypoglycemic unawareness due to DAN. After implementing an automated insulin delivery system, the glucose management improved significantly. Case 2 describes a 60-year-old patient with type 2 diabetes experiencing debilitating orthostatic hypotension. The initiation of Midodrine and Fludrocortisone markedly improved symptoms and capacity of daily activities. This observational study highlights the critical yet frequently overlooked severe manifestations of DAN/CAN, specifically hypoglycemic unawareness and orthostatic hypotension. CARTs play a pivotal role in confirming the diagnosis and guiding therapeutic decisions. Tailored interventions, including advanced technologies like automated insulin delivery systems for T1DM and pharmacotherapy targeting neurogenic orthostasis, can significantly improve patient outcomes and quality of life.
糖尿病自主神经病变（DAN）及其相关的心血管自主神经病变（CAN）可导致潜在的致命并发症。我们基于全面的心血管自主神经反射测试（CARTs）分析了两例不同的DAN/CAN病例。病例1涉及一名27岁的1型糖尿病患者，因DAN反复出现严重低血糖无意识状态。在实施自动胰岛素输送系统后，血糖管理得到显著改善。病例2描述了一名60岁的2型糖尿病患者，患有使人衰弱的体位性低血压。米多君和氟氢可的松的使用显著改善了症状和日常活动能力。这项观察性研究强调了DAN/CAN严重但常被忽视的表现，特别是低血糖无意识状态和体位性低血压。CARTs在确诊和指导治疗决策中起着关键作用。量身定制的干预措施，包括针对1型糖尿病的自动胰岛素输送系统等先进技术以及针对神经源性直立性低血压的药物治疗，可以显著改善患者的预后和生活质量。
