Most Diabetes Patients Unaware of
Deadly Condition that Develops
Without Symptoms, Survey Says

Up to Fifty Percent of patients with Diabetic Autonomic Neuropathy will die within five years after symptoms begin, but a new test aids in early detection

According to the results of a national survey released yesterday, ninety-two percent of the estimated 16 million Americans with diabetes have never heard of diabetic autonomic neuropathy, an often deadly but treatable condition that can develop for years without symptoms. The survey results were announced on the eve of the first Diabetes Health Expo, as over 10,000 attendees prepared to assemble for the largest gathering ever of people whose lives are affected by diabetes.

Also according to the survey, eighty-three percent of people with diabetes are unaware of a non-invasive procedure called heart rate variability testing. Physicians are more able to detect the presence of diabetic autonomic dysfunction when they augment their clinical evaluation with the information provided by heart rate variability testing. However, while it is estimated that diabetic autonomic neuropathy may affect more than twenty-five percent of people with diabetes, only two percent of survey respondents said that they have ever been tested for the condition.

The Diabetic Autonomic Neuropathy Awareness Survey polled a random sample of 313 diabetes patients in households nationwide. The survey was conducted by NFO Research, Inc., and commissioned by Boston Medical Technologies of Wakefield, Mass.

Diabetic autonomic neuropathy is the gradual breakdown of nearly every organ in the human body. It is easily confused with peripheral neuropathy, a more overtly symptomatic condition that affects the body's extremities. Experts believe that autonomic neuropathy could be responsible for the extremely high rate of cardiovascular death associated with diabetes. Among these potentially deadly complications is "silent" heart attack, which can progress undetected because autonomic neuropathy diminishes sensitivity to pain. Additional complications of this stealth condition include kidney failure, stroke, hypoglycemia unawareness, congestive heart failure and sexual dysfunction. With timely and proper treatment, however, diabetic autonomic neuropathy can be stopped and even reversed. (1)

Extensive published clinical data reports that heart rate variability testing, a non-invasive procedure covered by most insurers, can be used as an early indicator of autonomic nervous system dysfunction. (2), (3), (4), (5) The American Association of Clinical Endocrinologists and American Heart Association both recently declared heart rate variability as a recommended test for detecting autonomic dysfunction in diabetes. (6)

Despite this growing clinical consensus, heart rate variability testing is infrequently performed. Until recently, heart rate variability testing technology was only available to researchers, beyond the reach of treating physicians who care for the majority of people with diabetes. Now, however, hospitals and clinical practices are beginning to use a new heart rate variability system that enables treating physicians to easily test patients in their own offices.

According to California Endocrinologist Joseph Prendergast, MD, founder of diabeteswell.com, who is now using heart rate variability testing in his clinical practice, "These survey findings are a call to action for increased public awareness of diabetic autonomic neuropathy and the importance of early detection. Additionally, the survey findings reflect that people with diabetes are confusing heart rate variability testing with methods of detection for other types of neuropathy that have entirely different symptoms and consequences."

"Despite these disturbing survey results, the good news about diabetic autonomic neuropathy is that we can successfully treat it and now, for the first time, have the tools that can assist doctors in rendering an early and accurate diagnosis. This is critical, because diabetic autonomic neuropathy may already be present in patients whose blood sugar levels are higher than average, but still don't meet the traditional criteria for a diagnosis of diabetes," said Prendergast.

1. DCCT Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes: N Engl J Med 329:977-986, 1993

2. Vinik, Al, MD, PhD, and Suwanwalaikorn, S, MD: Autonomic Neuropathy, In deFronzo, R.M. (ed). Current Therapy of Diabetes Mellitus. Yearbook Inc. 1997; 165-176.

3. Robertson, D; Beck, C; Gary, T; Picklo, M: Classification of Autonomic Disorders. Int Angiol. 12 (2): 1993; 93-1002.

4. Low, PA. Autonomic Neuropathy. Semin Neurol 1987 Mar; 7 (1): 49-57.

5. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Circulation: Vol. 93, No. 5, 1996.

6. The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-management - 2000 Update, Endocrine Practice 2000; 6(1): 43-84; American Heart Association, 1999. AHA Scientific Statement: Diabetes and cardiovascular disease. Circulation 100:1134-1146.

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