Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management – published online 09/08/2024

Aikaterini Eleftheriadou, Vincenza Spallone, Abd A. Tahrani, Uazman Alam

Cardiac autonomic neuropathy (CAN) is a common, yet often under-recognised, complication of diabetes, associated with significant morbidity and mortality. In this issue, Eleftheriadou et al (https://doi.org/10.1007/s00125-024-06242-0) provide a comprehensive overview of CAN, detailing its pathophysiology, clinical presentation and management, including diagnosis, to aid clinicians in effectively addressing this condition. The authors highlight recent breakthroughs in understanding of the pathophysiology of CAN, including the roles of mitochondrial dysfunction, fatty acid metabolism, genetic factors and collagen turnover. Additionally, they compare diagnostic methods and discuss the potential utility of heart rate variability compared with traditional cardiovascular autonomic reflex tests. The review also covers the latest advancements in treatment, including the putative roles of the glucose-lowering agents such as sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. The authors conclude by discussing future research directions. The figures from this review are available as a downloadable slideset.

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