This is followed by a relative bradycardia that is maximal at approximately the 30th beat after standing. Diabetic autonomic neuropathy is a serious complication of diabetes. Therefore, they suggested that although CAN could be a contributing factor, it was not a significant independent cause of sudden death. The symptoms caused by gastrointestinal autonomic neuropathy in diabetes mellitus is important to highlight since it affects a large proportion of people with diabetes, regardless of whether this is type 1 or type 2. : Effects of physical training on heart rate variability in diabetic patients with various degrees of cardiovascular autonomic neuropathy. In healthy subjects, there is a characteristic and rapid increase in heart rate in response to standing that is maximal at approximately the 15th beat after standing. In the early 1970s, Ewing et al. The pooled estimate of the relative risk, based on 2,900 total subjects, was 2.14, with a 95% CI of 1.832.51 (P < 0.0001). The most advanced Autonomic test patterns of weak Parasympathetic function are Diabetic Autonomic Neuropathy (DAN), and Cardiac Autonomic Neuropathy (CAN) which has a 50% mortality rate within 5 years. (31) reported a 2.5-year mortality rate of 27.5\% that increased to 53\% after 5 years in diabetic patients with abnormal autonomic function tests compared with a mortality rate of only 15\% over the 5-year period among diabetic patients with normal autonomic function test results. Airaksinen KEJ, Koistinen MJ: Association between silent coronary artery disease, diabetes, and autonomic neuropathy. Cardiovascular autonomic function testing may help differentiate CAN from other causes of weakness, lightheadedness, dizziness, or fatigue and promote appropriate therapeutic intervention (62). . The multiple correlation between variables of PSA and the Ewing battery was high, and over 83% of cases were classified in an identical way by both diagnostic tests. These researchers went on to conclude that their investigation showed that short-term PSA of HRV is of similar diagnostic value as the Ewing battery concerning the presence of cardiovascular autonomic neuropathy (167). : Autonomic influence on cardiovascular performance in diabetic subjects. Electrogastrography detects abnormalities in GI pacemaking, but its role has not been established in diagnosis or treatment decision making. Increased oxidative stress, with increased free radical production, causes vascular endothelium damage and reduces nitric oxide bioavailability (12,13). Other factors that account for the marked variability in reported prevalence rates include the lack of a standard accepted definition of DAN, different diagnostic methods, variable study selection criteria, and referral bias (24). Clarke et al. Constipation is the most common GI complication, affecting nearly 60% of diabetic patients (1). The lack of interest in the development of such measures was partly due to the erroneous but commonly held view that autonomic neuropathy was only a small and relatively obscure contributor to the peripheral neuropathies affecting individuals with diabetes (116,118,120).

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