Abstract：
Cardiovascular autonomic neuropathy (CAN) is an under-recognised yet highly prevalent microvascular complication of diabetes. CAN affects approximately 20% of people with diabetes, with recent studies highlighting the presence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose), indicating early involvement of the autonomic nervous system. Understanding of the pathophysiology of CAN continues to evolve, with emerging evidence supporting a potential link between lipid metabolites, mitochondrial dysfunction and genetics. Recent advancements, such as streamlining CAN detection through wearable devices and monitoring of heart rate variability, present simplified and cost-effective approaches for early CAN detection. Further research on the optimal use of the extensive data provided by such devices is required. Despite the lack of specific pharmacological interventions targeting the underlying pathophysiology of autonomic neuropathy, several studies have suggested a favourable impact of newer glucose-lowering agents, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, where there is a wealth of clinical trial data on the prevention of cardiovascular events. This review delves into recent developments in the area of CAN, with emphasis on practical guidance to recognise and manage this underdiagnosed condition, which significantly increases the risk of cardiovascular events and mortality in diabetes.
摘要：
心血管自主神经病变（CAN）是一种未被认可但高度普遍的糖尿病微血管并发症。可以影响大约20％的糖尿病患者，最近的研究强调在糖尿病前期（糖耐量受损和/或空腹血糖受损）中存在CAN，表明自主神经系统早期受累。对CAN的病理生理学的理解继续发展，有新的证据支持脂质代谢物之间的潜在联系，线粒体功能障碍和遗传学。最近的进步，例如通过可穿戴设备简化CAN检测和监测心率变异性，提出了简化和经济有效的早期CAN检测方法。需要对此类设备提供的大量数据的最佳使用进行进一步研究。尽管缺乏针对自主神经病变的潜在病理生理学的特定药物干预措施，几项研究表明，新型降糖药物有有利的影响，如钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂，那里有大量预防心血管事件的临床试验数据。这篇综述深入探讨了CAN领域的最新发展，强调识别和管理这种未诊断疾病的实践指导，这显著增加了糖尿病患者心血管事件和死亡率的风险。
