Diabetic autonomic neuropathy (DAN), an underdiagnosed diabetes complication, is defined as ‘an autonomic nervous system disorder that results from changes caused by diabetes or prediabetes, after exclusion of other possible causes.’ It is due to damage to the small unmyelinated type C nerve fibers, and the clinical picture may vary from subclinical to symptomatic states, requiring specific tests for diagnosis confirmation. Several risk factors have been shown to contribute to DAN development, including diabetes duration, poor glucose control, obesity, dyslipidemia, high blood pressure, and microvascular complications.
Gold-standard diagnostic tests for DAN,...