Cardiovascular Autonomic Neuropathy among Diabetic Patients in a Tertiary Care Hospital in Odisha: A Cross-sectional Study

Background: Diabetes mellitus is a chronic disease associated with both modifiable and non-modifiable risk factors and is notorious for causing several systemic complications, often without early symptoms.Among these, cardiovascular autonomic neuropathy (CAN) remains underdiagnosed despite its serious implications.The condition affects multiple organ systems and can present with subtle clinical signs, leading to delayed recognition and treatment.Methods: A hospital-based cross-sectional study was conducted over two years at SLN Medical College and Hospital, Koraput, Odisha, involving 130 patients with a confirmed diagnosis of diabetes mellitus.Autonomic function was evaluated using cardiovascular reflex tests, including measurement of postural blood pressure changes, beat-to-beat heart rate variability, Valsalva ratio, and immediate heart rate response to standing.Data were analyzed using descriptive statistics. Results:The study included 84 males and 46 females, mostly aged over 55 years.Moderate postural hypotension (10-20 mmHg drop in systolic BP) was observed in over half of the participants, while approximately a quarter exhibited a significant drop exceeding 30 mmHg.Around one-third demonstrated beat-to-beat heart rate variability of less than 10 beats per minute, indicating autonomic dysfunction.About 29% showed abnormal Valsalva ratios (<1.10), and 35% exhibited impaired heart rate response to standing (30:15 ratio<1.00),indicating prevalent cardiovascular autonomic neuropathy.Conclusion: Cardiovascular autonomic neuropathy is a frequently overlooked yet serious complication among diabetic patients.Early detection using simple bedside autonomic tests can aid in timely diagnosis and management.Regular screening for CAN should be integrated into routine diabetic care, particularly in patients with longer disease duration and other comorbidities.