Diabetic Autonomic Neuropathy and Circadian Misalignment in Type 1 Diabetes

Misalignment of circadian rhythms has been evidenced in patients with type 1 diabetes and there is a close relationship between alterations in neuroendocrine sleep architecture, circa‐ dian clock oscillations, glucose metabolism, autonomic function, and diurnal profiles of blood pressure and heart rate [1-5]. In turn, circadian misalignment may modify the peak incidence of cardiovascular events in diabetic people [6-9]. Diabetic autonomic neuropathy, particularly cardiac autonomic neuropathy, is considered an important potential factor in‐ volved in the disruption of circadian cardiovascular rhythms [10]. This serious chronic com‐ plication is rarely diagnosed because it remains for a long times asymptomatic; contrariwise, it seems to have a significant prognostic value [10-12]. The review summarises the battery of non-invasive autonomic function tests available for diabetic autonomic neuropathy diagno‐ sis as well as cross-sectional and follow-up studies supporting their importance in risk strat‐ ification for diabetic micro-vascular complications and cardiovascular morbidity/mortality.