Dysautonomia in Diabetic Patients: A Study of 20 Cases

Introduction: Diabetes mellitus currently represents a major public health issue due to its numerous degenerative and functional complications. Among these, dysautonomia, long underdiagnosed, constitutes a frequent and potentially severe condition that may compromise patient prognosis. Patients and Methods: This prospective study involved 20 diabetic patients who underwent systematic autonomic nervous system evaluation. Assessments were conducted in a specialized cardiology unit using validated tests for heart rate variability, orthostatic response, and baroreflex sensitivity. Results: Results highlighted a predominantly parasympathetic impairment with: • Vagal deficit observed in 90% of patients, • Peripheral alpha-adrenergic failure and sympathetic hyperactivity in 50%, • Orthostatic hypotension in 30%, • Orthostatic hypertension in 10%, • Postural Orthostatic Tachycardia Syndrome (POTS) in 2% of cases. Discussion: This study reveals the vulnerability of diabetic patients to cardiac autonomic neuropathy (CAN), mainly characterized by vagal deficit. Sympathetic hyperactivity, often associated with hypertension, increases cardiovascular risk. POTS mainly affects young type 1 diabetic patients with low BMI. These results advocate for early and systematic screening of dysautonomia to improve management and quality of life of patients.