Symptomatic diabetic autonomic neuropathy common in adults w
About one in five adults with type 1 diabetes reports having symptomatic diabetic autonomic neuropathy. In findings from participants in the T1D Exchange clinic registry, adults who reported experiencing symptomatic diabetic autonomic neuropathy had higher risks for conditions ranging from cardiovascular disease and diabetic peripheral neuropathy to depression and opioid use when compared with those who did not report neuropathy.

Researchers collected data from 965 adults with type 1 diabetes participating in the T1D Exchange who completed a survey in February 2018 (64% women; 90% white; mean age, 40 years). Questionnaires were used to collect demographic data. The survey of autonomic symptoms was used to determine the presence and severity of diabetic autonomic neuropathy, with a higher score indicating worse symptoms. Participants who had a score higher than 3 of 11 points for women or 3 of 12 points for men were classified as having symptomatic diabetic autonomic neuropathy. Those with the condition were divided into severity categories of mild, moderate, severe and very severe using the 25th, 50th and 75th percentiles of the survey score.

Of the study cohort, 17% reported having symptomatic diabetic autonomic neuropathy. Mean HbA1c was higher in those with neuropathy and increased as severity of symptoms increased. Participants with neuropathy were more likely to report at least one severe hypoglycemic event (OR = 2.59; P = .002) and at least one diabetic ketoacidosis event (OR = 2.86; P = .05) in the 3 months before the survey compared with those without diabetic autonomic neuropathy.

Compared with those who did not have symptomatic diabetic autonomic neuropathy, adults with neuropathy had increased risks for CVD (OR = 1.51; P = .02), gastroparesis (OR = 2.32; P < .001) and diabetic peripheral neuropathy (OR = 3.41; P < .001). Those with neuropathy were also more likely to use opioids (OR = 1.99; P = .004), report anxiety (OR = 1.34; P = .03), report depression (OR = 1.47; P < .001) and have a lower annual income (P = .03) compared with those without neuropathy.