{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T20:16:53Z","timestamp":1781900213979,"version":"3.54.5"},"reference-count":131,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T00:00:00Z","timestamp":1677369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The manifestations of diabetic autonomic neuropathy (DAN) are protean and clinically involve multiple systems, including the cardiovascular system, the gastrointestinal system, the genitourinary system as well as the sweat glands (sudomotor dysfunction) and the gallbladder. In addition, cardiac autonomic neuropathy (CAN) is associated with a correctible inability to appreciate and correct hypoglycaemia. While not a clinical problem, pupillary involvement should be the clue and the catalyst to investigate for other manifestations of DAN. This review outlines a practical approach to detecting and investigating the manifestations of DAN. Of particular importance is early detection of cardiovascular involvement where prompt therapy through glycaemic control can decrease the severity of CAN and decelerate the frequency and severity of retinopathy and nephropathy in addition to decreasing cardiovascular events and mortality. CAN also plays a role in accelerating other diabetic complications such as acute ischaemic stroke, heart failure, medial artery calcinosis, foot ulcers, peripheral artery disease and Charcot joints. Many therapies of DAN are available, which should not only decrease morbidity and mortality from DAN, but also improve the patient's quality of life. However, the therapies available are largely symptomatic.<\/jats:p>","DOI":"10.1111\/dom.15004","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T02:09:27Z","timestamp":1675735767000},"page":"1162-1173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Detecting and treating the protean manifestations of diabetic autonomic neuropathy"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3035-6126","authenticated-orcid":false,"given":"David S. H.","family":"Bell","sequence":"first","affiliation":[{"name":"Southside Endocrinology  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,26]]},"reference":[{"key":"e_1_2_20_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-1303"},{"key":"e_1_2_20_3_1","first-page":"111","article-title":"Diabetic neuropathy medicine","volume":"24","author":"Randle RW","year":"1945","journal-title":"Baltimore"},{"key":"e_1_2_20_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-015-3534-7"},{"key":"e_1_2_20_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12111"},{"key":"e_1_2_20_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)00920-6"},{"key":"e_1_2_20_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102261\u20106\u201019"},{"key":"e_1_2_20_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02163.x"},{"key":"e_1_2_20_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-2175"},{"key":"e_1_2_20_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-019-00693-0"},{"key":"e_1_2_20_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1553"},{"key":"e_1_2_20_12_1","volume-title":"Diabetes in America","author":"Pop\u2010Busi R","year":"2018"},{"key":"e_1_2_20_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-305657"},{"key":"e_1_2_20_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.6.1895"},{"key":"e_1_2_20_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2021-002480"},{"key":"e_1_2_20_16_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006861112530"},{"issue":"3","key":"e_1_2_20_17_1","first-page":"559","article-title":"Elevation of serum and ventricular norepinephrine content in the diabetic rat","volume":"33","author":"Paulson DJ","year":"1981","journal-title":"Res Commun Chem Pathol Pharmacol"},{"key":"e_1_2_20_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.2040-4603.2022.tb00237.x"},{"key":"e_1_2_20_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0252511"},{"key":"e_1_2_20_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000117003"},{"key":"e_1_2_20_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.09.033"},{"key":"e_1_2_20_22_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2010.202838"},{"key":"e_1_2_20_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2004.01145.x"},{"key":"e_1_2_20_24_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011114627288"},{"issue":"3","key":"e_1_2_20_25_1","first-page":"271","article-title":"Arrhythmias and clinical electrophysiology of the transplanted human heart","volume":"2","author":"Liem LB","year":"1990","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"e_1_2_20_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.29.1.22"},{"key":"e_1_2_20_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-018-0130-5"},{"key":"e_1_2_20_28_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.17.6.578"},{"key":"e_1_2_20_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012185"},{"key":"e_1_2_20_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.35.3.787"},{"key":"e_1_2_20_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11207"},{"key":"e_1_2_20_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02034-7"},{"key":"e_1_2_20_33_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.2.339"},{"key":"e_1_2_20_34_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP-2017-0053"},{"key":"e_1_2_20_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-006-0074-z"},{"key":"e_1_2_20_36_1","doi-asserted-by":"publisher","DOI":"10.1515\/jbcpp-2020-0282"},{"key":"e_1_2_20_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-007-0535-7"},{"key":"e_1_2_20_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.06.006"},{"key":"e_1_2_20_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14233"},{"key":"e_1_2_20_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1995.tb00458.x"},{"key":"e_1_2_20_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.76.6.507"},{"key":"e_1_2_20_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0b013e3181ef621a"},{"key":"e_1_2_20_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/dtb.2016.5.0399"},{"key":"e_1_2_20_44_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S304012"},{"key":"e_1_2_20_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.11.066"},{"key":"e_1_2_20_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/CNQ.0000000000000086"},{"key":"e_1_2_20_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2020.102721"},{"key":"e_1_2_20_48_1","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200118070-00003"},{"key":"e_1_2_20_49_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11790"},{"key":"e_1_2_20_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-017-1791-y"},{"key":"e_1_2_20_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.05.007"},{"key":"e_1_2_20_52_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.837369"},{"key":"e_1_2_20_53_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.67.3.277"},{"key":"e_1_2_20_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5448.2011.00762.x"},{"key":"e_1_2_20_55_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0349"},{"key":"e_1_2_20_56_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-0793"},{"key":"e_1_2_20_57_1","doi-asserted-by":"publisher","DOI":"10.2337\/diab.41.4.430"},{"key":"e_1_2_20_58_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11441114"},{"key":"e_1_2_20_59_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013410"},{"key":"e_1_2_20_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0026-0495(03)00095-7"},{"key":"e_1_2_20_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2008.02567.x"},{"key":"e_1_2_20_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2003.07.001"},{"key":"e_1_2_20_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2432"},{"key":"e_1_2_20_64_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479164118805904"},{"key":"e_1_2_20_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00251822"},{"key":"e_1_2_20_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2020.01.006"},{"key":"e_1_2_20_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2021.12.002"},{"key":"e_1_2_20_68_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(1998120)15:4 <S57::AID-DIA741>3.0.CO;2-D"},{"key":"e_1_2_20_69_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26310"},{"key":"e_1_2_20_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.03862.x"},{"key":"e_1_2_20_71_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMicm1614893"},{"key":"e_1_2_20_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/dote.12354"},{"key":"e_1_2_20_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1985.tb00656.x"},{"key":"e_1_2_20_74_1","doi-asserted-by":"publisher","DOI":"10.1159\/000137725"},{"key":"e_1_2_20_75_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441\u2010198506000\u201000006"},{"key":"e_1_2_20_76_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.57.665.185"},{"key":"e_1_2_20_77_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1977.03630240061020"},{"key":"e_1_2_20_78_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.3.503"},{"key":"e_1_2_20_79_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365529108998583"},{"issue":"6","key":"e_1_2_20_80_1","first-page":"2648","article-title":"Study of paracetamol levels in serum samples as predictive indicator of gastric emptying","volume":"31","author":"Rodr\u00edguez Acosta MV","year":"2015","journal-title":"Nutr Hosp"},{"key":"e_1_2_20_81_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.373"},{"key":"e_1_2_20_82_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000320"},{"key":"e_1_2_20_83_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2018-00161"},{"key":"e_1_2_20_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2010.09.022"},{"key":"e_1_2_20_85_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00023.2008"},{"key":"e_1_2_20_86_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1C118"},{"key":"e_1_2_20_87_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.04189.x"},{"issue":"5","key":"e_1_2_20_88_1","first-page":"1230","article-title":"A double\u2010blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis","volume":"94","author":"Patterson D","year":"1999","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"e_1_2_20_89_1","first-page":"203","article-title":"The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronic oral erythromycin","volume":"88","author":"Richards RD","year":"1993","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_20_90_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-5491.2003.00872.x"},{"key":"e_1_2_20_91_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.6.1000"},{"key":"e_1_2_20_92_1","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.1982.11716090"},{"issue":"3","key":"e_1_2_20_93_1","first-page":"189","article-title":"Small intestinal manifestations of diabetes mellitus","volume":"56","author":"Miller LJ","year":"1983","journal-title":"Yale J Biol Med"},{"key":"e_1_2_20_94_1","doi-asserted-by":"publisher","DOI":"10.2337\/diab.5.4.289"},{"issue":"104","key":"e_1_2_20_95_1","first-page":"467","article-title":"Diabetic diarrhoea","volume":"26","author":"Malins JM","year":"1957","journal-title":"Q J Med"},{"key":"e_1_2_20_96_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6150.1462"},{"key":"e_1_2_20_97_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v16.i24.2978"},{"key":"e_1_2_20_98_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12479"},{"key":"e_1_2_20_99_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biotechadv.2011.08.008"},{"key":"e_1_2_20_100_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010863"},{"key":"e_1_2_20_101_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.611"},{"key":"e_1_2_20_102_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11938-017-0151-1"},{"key":"e_1_2_20_103_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02292770"},{"key":"e_1_2_20_104_1","doi-asserted-by":"publisher","DOI":"10.1159\/000371455"},{"key":"e_1_2_20_105_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1993.00410090019003"},{"key":"e_1_2_20_106_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2005.09.009"},{"key":"e_1_2_20_107_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2009.09.031"},{"key":"e_1_2_20_108_1","doi-asserted-by":"publisher","DOI":"10.1067\/mgn.2003.49"},{"key":"e_1_2_20_109_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.13935"},{"key":"e_1_2_20_110_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2012.07.011"},{"key":"e_1_2_20_111_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-6632(88)80024-2"},{"key":"e_1_2_20_112_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.12272"},{"key":"e_1_2_20_113_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.curtheres.2022.100669"},{"key":"e_1_2_20_114_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.02.108"},{"key":"e_1_2_20_115_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2008.01168.x"},{"key":"e_1_2_20_116_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2605.2008.00873.x"},{"key":"e_1_2_20_117_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000133278.81226.C9"},{"key":"e_1_2_20_118_1","doi-asserted-by":"publisher","DOI":"10.1177\/000331978403500203"},{"key":"e_1_2_20_119_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00184593"},{"key":"e_1_2_20_120_1","doi-asserted-by":"publisher","DOI":"10.5534\/wjmh.200007"},{"key":"e_1_2_20_121_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-53480-4.00017-5"},{"key":"e_1_2_20_122_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-0059"},{"key":"e_1_2_20_123_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14644"},{"key":"e_1_2_20_124_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200295030-00015"},{"key":"e_1_2_20_125_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250050677"},{"issue":"36","key":"e_1_2_20_126_1","first-page":"2200","article-title":"Vellykket behandling af diabetisk gustatorisk hyperhidrose med lokalappliceret glykopyrrolat [successful treatment of diabetic gustatory hyperhidrosis with topical glycopyrrolate]","volume":"173","author":"Lund NS","year":"2011","journal-title":"Ugeskr Laeger"},{"key":"e_1_2_20_127_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.07.123"},{"key":"e_1_2_20_128_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2015.03.003"},{"key":"e_1_2_20_129_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-120-6-199403150-00011"},{"key":"e_1_2_20_130_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1215228"},{"key":"e_1_2_20_131_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13561"},{"key":"e_1_2_20_132_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12752"}],"container-title":["Diabetes, Obesity and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dom.15004","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dom.15004","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/pdf\/10.1111\/dom.15004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:53:47Z","timestamp":1761893627000},"score":1,"resource":{"primary":{"URL":"https:\/\/dom-pubs.pericles-prod.literatumonline.com\/doi\/10.1111\/dom.15004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,26]]},"references-count":131,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1111\/dom.15004"],"URL":"https:\/\/doi.org\/10.1111\/dom.15004","archive":["Portico"],"relation":{"has-review":[{"id-type":"doi","id":"10.1111\/DOM.15004\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v2\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1111\/DOM.15004\/v1\/decision1","asserted-by":"object"}]},"ISSN":["1462-8902","1463-1326"],"issn-type":[{"value":"1462-8902","type":"print"},{"value":"1463-1326","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,26]]},"assertion":[{"value":"2022-12-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}