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CAN affects approximately 20% of people with diabetes, with recent studies highlighting the presence of CAN in prediabetes (impaired glucose tolerance and\/or impaired fasting glucose), indicating early involvement of the autonomic nervous system. Understanding of the pathophysiology of CAN continues to evolve, with emerging evidence supporting a potential link between lipid metabolites, mitochondrial dysfunction and genetics. Recent advancements, such as streamlining CAN detection through wearable devices and monitoring of heart rate variability, present simplified and cost-effective approaches for early CAN detection. Further research on the optimal use of the extensive data provided by such devices is required. Despite the lack of specific pharmacological interventions targeting the underlying pathophysiology of autonomic neuropathy, several studies have suggested a favourable impact of newer glucose-lowering agents, such as sodium\u2013glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, where there is a wealth of clinical trial data on the prevention of cardiovascular events. This review delves into recent developments in the area of CAN, with emphasis on practical guidance to recognise and manage this underdiagnosed condition, which significantly increases the risk of cardiovascular events and mortality in diabetes.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>","DOI":"10.1007\/s00125-024-06242-0","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T11:02:27Z","timestamp":1723201347000},"page":"2611-2625","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management"],"prefix":"10.1007","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7290-8523","authenticated-orcid":false,"given":"Aikaterini","family":"Eleftheriadou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8905-216X","authenticated-orcid":false,"given":"Vincenza","family":"Spallone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9037-1937","authenticated-orcid":false,"given":"Abd A.","family":"Tahrani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3190-1122","authenticated-orcid":false,"given":"Uazman","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"issue":"1","key":"6242_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4093\/dmj.2018.0259","volume":"43","author":"V Spallone","year":"2019","unstructured":"Spallone V (2019) Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet. 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AAT is currently an employee and shareholder of Novo Nordisk. Novo Nordisk had no role in this project and the views represented are those of the author and not Novo Nordisk. UA has received honoraria from Procter & Gamble, Viatris, Eli Lilly,\u00a0Grunenthal and Sanofi for educational meetings and has received investigator-led funding from Procter & Gamble. UA has received sponsorship for travel to an international conference from Daiichi Sankyo. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"All authors contributed to drafting the article and critically reviewing it for important intellectual content. All authors approved the final version to be published.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}