MORTALITY IN DIABETIC AUTONOMIC NEUROPATHY

Diabetics (37) with symptoms and clinical features suggestive of autonomic neuropathy were followed for 33 mo. Of the 20 with abnormal Valsalva or handgrip tests initially, 10 (50%) died. There were no other features at presentation that differentiated those who subsequently died from those who survived. The causes of death were renal failure (6 patients), cerebrovascular accident (2 patients), hypoglycemic coma (1 patient) and sudden death (1 patient). Of the survivors whose autonomic function tests were repeated 18 mo.-2 yr later, 5 had new or worsening symptoms of autonomic neuropathy with corresponding deterioration of their autonomic-function tests; while 2, with initially normal tests, had improved symptomatically. In diabetics with the clinical features of autonomic neuropathy simple autonomic-function tests give a good guide to prognosis, and abnormal tests are associated with a high mortality.