Autonomic neuropathy — a form of diabetic neuropathy that affects the nerves controlling basic bodily functions — is severe enough to cause symptoms in about one in five adults with type 1 diabetes, according to a new study published in the Journal of Diabetes and its Complications.
The most widely known form of neuropathy that affects people with diabetes is peripheral neuropathy, which typically causes symptoms like burning, tingling, or numbness in the feet and legs. Autonomic neuropathy, on the other hand, involves damage to the nerves that carry information from the brain and spinal cord — so it can disrupt the function of many different processes in the body. Sometimes, autonomic neuropathy may not cause any noticeable symptoms — even if it’s disrupting the function of a major organ like the heart. But in certain cases, autonomic neuropathy can change the function of areas like the heart, bladder, digestive system, or sweat glands in a way that causes noticeable signs.
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For the latest study, researchers looked at survey responses from 965 adults with type 1 diabetes who were participants in a program called the T1D Exchange Clinic Registry. Each participant took the survey between 2010 and 2017, and had had diabetes for at least five years at the time of the survey. The average age of participants was 40, with a median diabetes duration of 20 years.
Various factors linked to increased rate of autonomic neuropathy
Overall, 166 participants (17%) indicated that they had symptoms suggesting diabetic autonomic neuropathy. Out of these participants with symptoms, 72% said that their symptoms were of moderate severity or worse. Compared with participants who didn’t experience symptoms of autonomic neuropathy, those who did experience them tended to have a higher A1C level (a measure of long-term blood glucose control) and to have a longer duration of diabetes. They were also more likely to be female, to have a lower income, to smoke, to use opioids, to experience depression, or to have cardiovascular disease. Not surprisingly, participants with symptoms of autonomic neuropathy were also more likely to experience peripheral neuropathy.
Certain factors were particularly linked to symptoms of autonomic neuropathy, as noted in a Healio article on the study. Compared with participants who didn’t have symptoms of autonomic neuropathy, those who had them were 47% more likely to have depression, 51% more likely to have cardiovascular disease, 99% more likely to use opioids, and 132% more likely to experience gastroparesis (slowed stomach emptying). It’s possible that in at least some cases, gastroparesis develops as a result of autonomic neuropathy.
“[Diabetic autonomic neuropathy] symptoms are common in [type 1 diabetes],” the researchers concluded. “Socioeconomic factors and psychological comorbidities may contribute to [diabetic autonomic neuropathy] symptoms and should be explored further.”