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Dissociated sensory loss in diabetic autonomic neuropathy
Author(s) -
Winkler A. S.,
Ejskjaer N.,
Edmonds M.,
Watkins P. J.
Publication year - 2000
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2000.00298.x
Subject(s) - medicine , sensation , diabetes mellitus , stimulus modality , autonomic neuropathy , diabetic neuropathy , disease , autonomic function , type 2 diabetes mellitus , surgery , sensory system , gastroenterology , endocrinology , blood pressure , heart rate variability , heart rate , neuroscience , cell culture , biology , neuroblastoma , genetics
Summary Aims Clinical observation has led to the idea that there might be a distinctive form of selective sensory and autonomic neuropathy affecting patients with Type 1 diabetic mellitus with severe symptomatic autonomic neuropathy (Type 1‐DAN) and this study was conducted to evaluate the presence of such a neuropathy in Type 1‐DAN. Methods Nineteen Type 1 diabetic patients presenting for treatment of severe symptomatic autonomic neuropathy were examined (all had ≥ 2 autonomic symptoms; age 39.3 ± 10.2 years; duration of disease 25.6 ± 10.5 years). For comparison, 19 Type 1 diabetic patients with neuropathic foot ulcers (age 44.5 ± 6.6 years; duration of disease 26.7 ± 9.2 years), 14 clinically uncomplicated Type 1 diabetic patients (age 39.9 ± 5.6 years; duration of disease 22.9 ± 9.3 years) and 16 non‐diabetic healthy people as controls (age 39.3 ± 10.7 years) were also examined. Results The large fibre modalities (light touch and vibration perception) were better preserved in the Type 1‐DAN group than in the foot ulcer group. Thus, light touch sensation was normal in 11 out of 19 Type 1‐DAN patients compared to only three out of 19 foot ulcer patients ( P < 0.01), and vibration perception was 24.9 ± 15.0 V and 40.5 ± 7.9 V, respectively ( P < 0.002) with some of the Type 1‐DAN patients in the normal range. In contrast, the small fibre modalities, thermal perception and autonomic function, were grossly abnormal in both groups (hot thermal perception 14.1 ± 2.5°C and 12.6 ± 3.7°C; cold thermal perception 13.8 ± 2.7°C and 10.9 ± 4.7°C; heart rate variation 2.9 ± 1.5 beats/min and 4.8 ± 4.0 beats/min, respectively). Conclusions There is indeed a subgroup of Type 1 diabetic neuropathy patients who suffer from severe autonomic symptoms associated with a selective small fibre sensory and autonomic loss with relatively preserved large fibre sensory modalities.