Diagnosis and Treatment Algorithm of Diabetic Autonomic Neuropathy - Flowchart
Diagnosis and Treatment Algorithm of Diabetic Autonomic Neuropathy - Flowchart Diabetic Polyneuropathy Diabetic Polyneuropathy
«Flowchart»

Screen

Type 1 DM: Screen after 5 yr, Type 2 DM: Screen at diagnosis, then if normal, repeat yearly

Screen

Type 1 DM: Screen after 5 yr, Type 2 DM: Screen at diagnosis, then if normal, repeat yearly

Screen

Type 1 DM: Screen after 5 yr, Type 2 DM: Screen at diagnosis, then if normal, repeat yearly

Intensive multifactorial preventive management (control of BP, lipids, HbA1c, lifestyle, diet, etc.)

Intensive multifactorial preventive management (control of BP, lipids, HbA1c, lifestyle, diet, etc.)

Intensive multifactorial preventive management (control of BP, lipids, HbA1c, lifestyle, diet, etc.)

Suspect diabetic autonomic neuropathy

Suspect diabetic autonomic neuropathy

Suspect diabetic autonomic neuropathy

Diagnosis

HRV test, clinical symptoms and signs

Diagnosis

HRV test, clinical symptoms and signs

Diagnosis

HRV test, clinical symptoms and signs

Monitoring

Monitoring every year for response to treatment

Monitoring

Monitoring every year for response to treatment

Monitoring

Monitoring every year for response to treatment

End

End

End

Confirm diagnosis

Endoscopy, barium study, manometry, emptying study

Confirm diagnosis

Endoscopy, barium study, manometry, emptying study

Confirm diagnosis

Endoscopy, barium study, manometry, emptying study

Confirm diagnosis

Sudomotor test, SSR, sweat imprint, skin blood flow

Confirm diagnosis

Sudomotor test, SSR, sweat imprint, skin blood flow

Confirm diagnosis

Sudomotor test, SSR, sweat imprint, skin blood flow

Confirm diagnosis

Cystometrogram, postvoiding sonogram

Confirm diagnosis

Cystometrogram, postvoiding sonogram

Confirm diagnosis

Cystometrogram, postvoiding sonogram

Treatment

Symptomatic treatment

Treatment

Symptomatic treatment

Treatment

Symptomatic treatment

Confirm diagnosis

Measure BP in standing and supine position, catecholamines

Confirm diagnosis

Measure BP in standing and supine position, catecholamines

Confirm diagnosis

Measure BP in standing and supine position, catecholamines

Confirm diagnosis

Measure penile-brachial pressure index, nocturnal penile tumescence

Confirm diagnosis

Measure penile-brachial pressure index, nocturnal penile tumescence

Confirm diagnosis

Measure penile-brachial pressure index, nocturnal penile tumescence

Cardiac symptoms

Cardiac symptoms

Cardiac symptoms

Bladder dysfunction

Bladder dysfunction

Bladder dysfunction

Sexual dysfunction

Sexual dysfunction

Sexual dysfunction

Postural hypotension

Postural hypotension

Postural hypotension

GI symptoms

GI symptoms

GI symptoms

Hyper/hypohidrosis

Hyper/hypohidrosis

Hyper/hypohidrosis

ACE inhibitors, beta-blockers, antioxidants, ARBs

ACE inhibitors, beta-blockers, antioxidants, ARBs

ACE inhibitors

Bethanechol, intermittent catheterization

Bethanechol, intermittent catheterization

Bethanechol

Phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil), sex therapy, psychological counseling

Phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil), sex therapy, psychological counseling

Phosphodiesterase type 5 inhibitors

Supportive garments, octreotide, midodrine, clonidine

Supportive garments, octreotide, midodrine, clonidine

Supportive garments

Prokinetic agents, bulking agent, tricyclic antidepressant, pancreatic extract

Prokinetic agents, bulking agent, tricyclic antidepressant, pancreatic extract

Prokinetic agents

Scopolamine, botulinum toxin, lachydrine, vasodilators

Scopolamine, botulinum toxin, lachydrine, vasodilators

Scopolamine

Negative

Negative

Negative

Positive

Positive

Positive

ACE, Angiotensinconverting enzyme; ARBs, angiotensin receptor blockers; BP, blood pressure; DM, diabetes mellitus; GI, gastrointestinal; HRV, heart rate variability; SSR, sympathetic skin response.

ACE, Angiotensinconverting enzyme; ARBs, angiotensin receptor blockers; BP, blood pressure; DM, diabetes mellitus; GI, gastrointestinal; HRV, heart rate variability; SSR, sympathetic skin response.

ACE, Angiotensinconverting enzyme; ARBs, angiotensin receptor blockers; BP, blood pressure; DM, diabetes mellitus; GI, gastrointestinal; HRV, heart rate variability; SSR, sympathetic skin response.

ACE ARBs BP DM GI HRV SSR