Diabetic neuropathy associated complications,
which affects all major organs of the body, are common in Type 1 and Type 2
diabetes. Cardiac diabetic neuropathy is characterised by damage to nerves
regulating the heart rate and any changes in the capacity of these nerves to
modulate heart rate leads to changes to heart rate variability (HRV).
Its prevalence lies between 20% and 60% in
patients with diabetes, with a mortality that is approximately five times
higher.Testing for cardiac autonomic neuropathy (CAN)
in people with
diabetes was traditionally based on five Ewing cardiac reflex tests that
constitute the gold standard.
Recent research has been investigating the
efficacy of alternative diagnostic tests, using ECG attributes to address
shortcomings of the Ewing battery as a number of the Ewing tests included in
the Ewing battery are often counter-indicated for patients with
cardiorespiratory comorbidity, frail or severely obese patients.
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