Review article
Insulin Resistance and Diabetic Autonomic Neuropathy
Nikica Car
Maja Bakula
Abstract
Diabetic autonomic neuropathy is an
important chronic complication of diabetes that affects many
physiological systems and is associated with a signifi cant
deterioration in the quality of life and increased morbidity and
mortality. The exact pathological mechanism responsible
for this damage is unknown. Epidemiological studies have
shown that insulin resistance and hyperinsulinism are
associated with an increased sympathetic nervous system
activity. Based on the results of research in children of
type 2 diabetic patients (who are often insulin resistant
despite normal glucose tolerance), it is considered that
insulin resistance and compensatory hyperinsulinemia
represent early pathophysiological changes related to
the development of autonomic dysfunction. The latter is
responsible for the subsequent development of hypertension
and/or type 2 diabetes. In autonomic cardiac regulation
studies performed on the same model, a statistically
signifi cant increase in heart rate and sympatho-vagal
cardiac tone ratio was observed. The results of these
studies suggest that autonomic dysfunction develops
earlier than previously thought, connecting it to parenteral
type 2 diabetes. The treatment of diabetic neuropathy is
less than satisfactory. Most often, the improved glycemic
control is not accompanied with the improvement in
diabetic neuropathy symptoms. The mainstays of therapy
are avoidance of neurotoxins (alcohol), administration of
antioxidants and symptomatic treatment. Possible favorable
effects of metformin were also described.
Keywords
autonomic nervous system; autonomic neuropathy; insulin resistance; hyperinsulinemia; type 2 diabetes mellitus
Hrčak ID:
18991
URI
Publication date:
15.11.2004.
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