{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:44:37Z","timestamp":1793367877273,"version":"4.5.0"},"reference-count":67,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T00:00:00Z","timestamp":1681603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Apoyo a la Publicaciones Open Acces de la Universidad de las Americas de Chile"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and\/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD.<\/jats:p>","DOI":"10.3390\/medicina59040770","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T03:14:09Z","timestamp":1681701249000},"page":"770","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Reactive Hyperemia and Cardiovascular Autonomic Neuropathy in Type 2 Diabetic Patients: A Systematic Review of Randomized and Nonrandomized Clinical Trials"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2622-5051","authenticated-orcid":false,"given":"Erislandis","family":"L\u00f3pez-Gal\u00e1n","sequence":"first","affiliation":[{"name":"Facultad de Medicina 2, Universidad de Ciencias M\u00e9dicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arqu\u00edmedes","family":"Montoya-Pedr\u00f3n","sequence":"additional","affiliation":[{"name":"Departamento de Neurofisiolog\u00eda Cl\u00ednica, Hospital Cl\u00ednico Quir\u00fargico Juan Brunos Zayas Alfonso, Universidad de Ciencias M\u00e9dicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Barrio-Deler","sequence":"additional","affiliation":[{"name":"Hospital Infantil Norte Juan de la Cruz Mart\u00ednez Maceira, Universidad de Ciencias M\u00e9dicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9461-203X","authenticated-orcid":false,"given":"Miguel Enrique","family":"S\u00e1nchez-Hechavarr\u00eda","sequence":"additional","affiliation":[{"name":"Departamento de Ciencias Cl\u00ednicas y Precl\u00ednicas, Facultad de Medicina, Universidad Cat\u00f3lica de la Sant\u00edsima Concepci\u00f3n, Concepci\u00f3n 4090541, Chile"},{"name":"N\u00facleo Cient\u00edfico de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Adventista de Chile, Chill\u00e1n 3780000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Eugenio","family":"Mu\u00f1oz-Bustos","sequence":"additional","affiliation":[{"name":"Departamento de Kinesiolog\u00eda, Facultad de Medicina, Universidad de Concepci\u00f3n, Concepci\u00f3n 4030000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5351-3016","authenticated-orcid":false,"given":"Gustavo Alejandro","family":"Mu\u00f1oz-Bustos","sequence":"additional","affiliation":[{"name":"Escuela de Kinesiolog\u00eda, Facultad de Salud y Ciencias Sociales, Campus El Boldal, Sede Concepci\u00f3n, Universidad de las Am\u00e9ricas, Concepcion 4030000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,16]]},"reference":[{"key":"ref_1","unstructured":"(2021, March 31). International Diabetes Federation\u2014Home. Available online: https:\/\/idf.org\/atlas-idf-2019\/."},{"key":"ref_2","unstructured":"Shlomo, M., Polonsky, K.S., Kronenberg, H.M., and Reed Larsen, P. (2017). Williams Tratado de Endocrinolog\u00eda, Saunders Elsevier Inc.. [13th ed.]."},{"key":"ref_3","unstructured":"Hassan, G.S. (2006). Ewing Battery Used for Diagnosis of Autonomic Neuropathy in Type 2 Diabetic Patients in Babylon Governorate. Med. J. Babylon, 3, Available online: https:\/\/www.iasj.net\/iasj\/download\/fc44f1ae161432e8."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e012509","DOI":"10.1161\/JAHA.119.012509","article-title":"Endothelial Function Assessed by Digital Volume Plethysmography Predicts the Development and Progression of Type 2 Diabetes Mellitus","volume":"8","author":"Hahad","year":"2019","journal-title":"J. Am. Heart Assoc. Cardiovasc. Cerebrovasc. Dis."},{"key":"ref_5","first-page":"305","article-title":"Diabetic neuropathy: Current concepts","volume":"2","author":"Bhadada","year":"2001","journal-title":"Indian Acad. Clin. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/ajhp\/61.2.160","article-title":"Diabetic neuropathy intensive review","volume":"61","author":"Duby","year":"2004","journal-title":"Am. Soc. Health-Syst. Pharm."},{"key":"ref_7","unstructured":"Ravindranathan, D. (2009). Photoplethysmography for the Evaluation of Diabetic Autonomic Neuropathy, Cardiff University. Available online: https:\/\/orca.cardiff.ac.uk\/54981\/1\/U585370.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wei, H.-C., Ta, N., Hu, W.-R., Xiao, M.-X., Tang, X.-J., Haryadi, B., Liou, J.J., and Wu, H.-T. (2019). Digital Volume Pulse Measured at the Fingertip as an Indicator of Diabetic Peripheral Neuropathy in the Aged and Diabetic. Entropy, 21, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7514575\/.","DOI":"10.3390\/e21121229"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4539","DOI":"10.1364\/BOE.9.004539","article-title":"Muscular blood flow responses as an early predictor of the severity of diabetic neuropathy at a later stage in streptozotocin-induced type I diabetic rats: A diffuse correlation spectroscopy study","volume":"9","author":"Ono","year":"2018","journal-title":"Biomed. Opt. Express"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wei, H.-C., Ta, N., Hu, W.-R., Wang, S.-Y., Xiao, M.-X., Tang, X.-J., Chen, J.-J., and Wu, H.-T. (2020). Percussion Entropy Analysis of Synchronized ECG and PPG Signals as a Prognostic Indicator for Future Peripheral Neuropathy in Type 2 Diabetic Subjects. Diagnostics, 10, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7168256\/.","DOI":"10.3390\/diagnostics10010032"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s40200-014-0118-x","article-title":"A cross-sectional assessment to detect type 2 diabetes with endothelial and autonomic nervous system markers using a novel system","volume":"13","author":"Lewis","year":"2014","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/00007611-200295010-00005","article-title":"Neuropathy: New concepts in evaluation and treatment","volume":"95","author":"Vinik","year":"2002","journal-title":"South. Med. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"928","DOI":"10.3949\/ccjm.68.11.928","article-title":"Recognizing and treating diabetic autonomic neuropathy","volume":"68","author":"Vinik","year":"2001","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4239\/wjd.v9.i1.1","article-title":"Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment","volume":"9","author":"Serhiyenko","year":"2018","journal-title":"World J. Diabetes"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e000606","DOI":"10.1136\/bmjdrc-2018-000606","article-title":"Comparison of endothelial function and sympathetic nervous system activity along the glucose continuum in individuals with differing metabolic risk profiles and low dietary sodium intake","volume":"7","author":"Baqar","year":"2019","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e001004","DOI":"10.1136\/bmjdrc-2019-001004","article-title":"Vasomodulation of peripheral blood flow by focused ultrasound potentiates improvement of diabetic neuropathy","volume":"8","author":"Tan","year":"2020","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Maiuolo, J., Gliozzi, M., Musolino, V., Carresi, C., Nucera, S., Macr\u00ec, R., Scicchitano, M., Bosco, F., Scarano, F., and Ruga, S. (2019). The Role of Endothelial Dysfunction in Peripheral Blood Nerve Barrier: Molecular Mechanisms and Pathophysiological Implications. Int. J. Mol. Sci., 20, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6628074\/.","DOI":"10.3390\/ijms20123022"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"419","DOI":"10.2147\/DMSO.S129797","article-title":"Cardiac autonomic neuropathy in patients with diabetes mellitus: Current perspectives","volume":"10","author":"Fisher","year":"2017","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.2337\/diacare.26.5.1553","article-title":"Diabetic Autonomic Neuropathy","volume":"26","author":"Vinik","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000235","DOI":"10.1136\/bmjdrc-2016-000235","article-title":"Peripheral sensory neuropathy is associated with altered postocclusive reactive hyperemia in the diabetic foot","volume":"4","author":"Barwick","year":"2016","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s11892-014-0541-x","article-title":"Microvascular Dysfunction in the Context of Diabetic Neuropathy","volume":"14","author":"Stirban","year":"2014","journal-title":"Curr. Diabetes Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/BF00402283","article-title":"Endoneuriallocalisation of microvascular damage in human diabetic neuropathy","volume":"36","author":"Malik","year":"1993","journal-title":"Diabetologia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/dmrr.2239","article-title":"Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy","volume":"28","author":"Tesfaye","year":"2012","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/dmrr.1239","article-title":"Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management","volume":"27","author":"Spallone","year":"2011","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2337\/dc16-2042","article-title":"Diabetic Neuropathy: A Position Statement by the American Diabetes Association","volume":"40","author":"Boulton","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/s-0034-1366435","article-title":"Diabetic Neuropathy","volume":"122","author":"Ziegler","year":"2014","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1002\/(SICI)1097-4598(199712)20:12<1561::AID-MUS11>3.0.CO;2-3","article-title":"Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects","volume":"20","author":"Low","year":"1997","journal-title":"Muscle Nerve"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s12265-012-9367-6","article-title":"What Do We Know and We Do Not Know About Cardiovascular Autonomic Neuropathy in Diabetes","volume":"5","year":"2012","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"5316769","DOI":"10.1155\/2020\/5316769","article-title":"Combination of Composite Autonomic Symptom Score 31 and Heart Rate Variability for Diagnosis of Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes","volume":"2020","author":"Zhang","year":"2020","journal-title":"J. Diabetes Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"dos Santos Corr\u00eaa, A.P., AntunesFetter, C., Ramos Figueira, F., Axmann de Castro, M., Pinto Ribeiro, J., and D\u2019AgordSchaan, B. (2015). Effect of Acute Inspiratory Muscle Exercise on Blood Flow of Resting and Exercising Limbs and Glucose Levels in Type 2 Diabetes. PLoS ONE, 10, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4372446\/.","DOI":"10.1371\/journal.pone.0121384"},{"key":"ref_31","first-page":"1","article-title":"Detectionofneuropathyusing a sudomotor test in type 2 diabetes","volume":"5","author":"Gandhi","year":"2015","journal-title":"Degener. Neurol. Neuromuscul. Dis."},{"key":"ref_32","unstructured":"Robles Cabrera, A. (2022, February 23). Regulaci\u00f3n Auton\u00f3mica de la Frecuencia Cardiaca y la Presi\u00f3n Arterial Sist\u00f3lica Ante el Ortostatismo y la Respiraci\u00f3n R\u00edtmica Controlada en Sujetos Diab\u00e9ticos de Corta (<2 a\u00f1os de diagn\u00f3stico) y Larga Evoluci\u00f3n (>2 A\u00f1os de Diagn\u00f3stico) del Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n Durante el Per\u00edodo Comprendido Entre Agosto de 2008 a Agosto de 2014. Available online: https:\/\/repositorioinstitucional.buap.mx\/handle\/20.500.12371\/8878."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jtbi.2013.03.022","article-title":"Assessment of autonomic dysfunction in patients with type 2 diabetes using reactive hyperemia","volume":"330","author":"Wu","year":"2013","journal-title":"J. Theor. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Palazzo, P., Maggio, P., Altavilla, R., Di Flaviani, A., Giordani, I., Malandrucco, I., Picconi, F., Passarelli, F., Pasqualetti, P., and Ercolani, M. (2013). Cerebral Hemodynamics and Systemic Endothelial Function Are Already Impaired in Well-Controlled Type 2 Diabetic Patients, with Short-Term Disease. PLoS ONE, 8, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3877017\/.","DOI":"10.1371\/journal.pone.0083287"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.diabres.2019.04.015","article-title":"Cardiac syncope recurrence in type 2 diabetes mellitus patients vs. normoglycemics patients: The CARVAS study","volume":"151","author":"Sardu","year":"2019","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s12471-011-0202-5","article-title":"Approaches for non-invasive assessment of endothelial function: Focus on peripheral arterial tonometry","volume":"21","author":"Peters","year":"2013","journal-title":"Neth. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"443","DOI":"10.20452\/pamw.1879","article-title":"Endothelial function assessment in atherosclerosis. Comparison of brachial artery flow-mediated vasodilation and peripheral arterial tonometry","volume":"123","author":"Wilk","year":"2013","journal-title":"Pol. Arch. Med. Wewn."},{"key":"ref_38","unstructured":"Olamaei, N. (2009). Reactive Hyperemia as Endothelial Function Determinant Using Plethysmography Methods, Biomedical Engineering Institute Faculty of Medicine, Montreal University. Available online: https:\/\/papyrus.bib.umontreal.ca\/xmlui\/bitstream\/handle\/1866\/2854\/OlamaeiNina_2009_memoire.pdf."},{"key":"ref_39","first-page":"279","article-title":"Evaluaci\u00f3n cl\u00ednica del pletism\u00f3grafo digital Angiodin PD 3000: Estudio fase II","volume":"20","author":"Figueroa","year":"2001","journal-title":"Rev. Cuba. Investig. Biom\u00e9dicas"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1152\/japplphysiol.01253.2013","article-title":"Positional differences in reactive hyperemia provide insight into initial phase of exercise hyperemia","volume":"119","author":"Jasperse","year":"2015","journal-title":"J. Appl. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2220\/biomedres.37.73","article-title":"Postcontraction hyperemia after electrical stimulation: Potential utility in rehabilitation of patients with upper extremity paralysis","volume":"37","author":"Shibata","year":"2016","journal-title":"Biomed. Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Pettit, A.P., Kipen, H., Laumbach, R., Ohman-Strickland, P., Kelly-McNeill, K., Cepeda, C., Fan, Z.-H., Amorosa, L., Lubitz, S., and Schneider, S. (2015). Disrupted Nitric Oxide Metabolism from Type II Diabetes and Acute Exposure to Particulate Air Pollution. PLoS ONE, 10, Available online: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4682772\/.","DOI":"10.1371\/journal.pone.0144250"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"602","DOI":"10.3389\/fbioe.2020.00602","article-title":"Impaired Microvascular Response to Muscle Stretching in Chronic Smokers With Type 2 Diabetes","volume":"8","author":"Low","year":"2020","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3164\/jcbn.14-71","article-title":"Contribution of nitrergic nerve in canine gingival reactive hyperemia","volume":"56","author":"Shimada","year":"2015","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/s00421-010-1769-z","article-title":"Effects of Limb Posture on Reactive Hyperemia","volume":"111","author":"Krishnan","year":"2011","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e00193","DOI":"10.1002\/phy2.193","article-title":"Acute impact of retrograde shear rate on brachial and superficial femoral artery flow-mediated dilation in humans","volume":"2","author":"Schreuder","year":"2014","journal-title":"Physiol. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1152\/japplphysiol.00110.2014","article-title":"Sympathetic nervous system activation, arterial shear rate, and flow-mediated dilation","volume":"116","author":"Thijssen","year":"2014","journal-title":"J. Appl. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1093\/eurheartj\/eht308.P1436","article-title":"The difference of the influence of autonomic nervous activation caused by reactive hyperemia on two different endothelial function tests","volume":"34","author":"Yoshida","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1111\/cen.12803","article-title":"Sympathetic activation and endothelial dysfunction in polycystic ovary syndrome are not explained by either obesity or insulin resistance","volume":"83","author":"Lambert","year":"2015","journal-title":"Clin. Endocrinol."},{"key":"ref_50","first-page":"973","article-title":"Vascular health in children and adolescents: Effects of obesity and diabetes","volume":"5","author":"Short","year":"2009","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Petrofsky, J., Lee, S., and Cuneo, M. (2005). Effects of aging and type 2 diabetes on resting and post occlusive hyperemia of the forearm; the impact of rosiglitazone. BMC Endocr. Disord., 5, Available online: http:\/\/www.biomedcentral.com\/1472-6823\/5\/4.","DOI":"10.1186\/1472-6823-5-4"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/657103","article-title":"The Influence of Autonomic Dysfunction Associated with Aging and Type 2 Diabetes on Daily Life Activities","volume":"2012","author":"Petrofsky","year":"2012","journal-title":"Exp. Diabetes Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.2169\/internalmedicine.1564-18","article-title":"A Study of the Vascular Endothelial Function in Patients with Type 2 Diabetes Mellitus and Rheumatoid Arthritis","volume":"58","author":"Mori","year":"2019","journal-title":"Intern. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1113\/jphysiol.2007.143867","article-title":"Human cutaneous reactive hyperaemia: Role of BKCa channels and sensory nerves","volume":"585","author":"Lorenzo","year":"2007","journal-title":"J. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Nouri, M.N., Ahmed, A., Bril, V., Orszag, A., Ng, E., Nwe, P., and Perkins, B.A. (2012). Diabetic neuropathy and axon reflex-mediated neurogenic vasodilatation in type 1 diabetes. PLoS ONE, 7, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/22529938\/.","DOI":"10.1371\/journal.pone.0034807"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Circulation, 93, 1043\u20131065. Available online: https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.93.5.1043.","DOI":"10.1161\/01.CIR.93.5.1043"},{"key":"ref_57","first-page":"71","article-title":"Detection of diabetic autonomic neuropathy in diabetes mellitus type 2","volume":"5","author":"Seyhood","year":"2008","journal-title":"Med. J. Babylon"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1161\/01.CIR.100.8.813","article-title":"Effects of Autonomic Neuropathy on Coronary Blood Flow in Patients with Diabetes Mellitus","volume":"100","author":"Landa","year":"1999","journal-title":"Circulation"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12933-021-01337-z","article-title":"Assessment of heart rate variability (HRV) in subjects with type 2 diabetes mellitus with and without diabetic foot: Correlations with endothelial dysfunction indices and markers of adipo-inflammatory dysfunction","volume":"20","author":"Tuttolomondo","year":"2021","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1111\/j.2040-1124.2012.00230.x","article-title":"Endothelial impairment and bone marrow-derived CD34+\/133+ cells in diabetic patients with erectile dysfunction","volume":"3","author":"Murata","year":"2012","journal-title":"J. Diabetes Investig."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/0167-5273(93)90081-Q","article-title":"Somatic pain threshold and reactive hyperemia in autonomic diabetic neuropathy and silent myocardial ischemia","volume":"42","author":"Hartmann","year":"1993","journal-title":"Int. J. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"653277","DOI":"10.3389\/fendo.2021.653277","article-title":"Small fibre neuropathy is associated with impaired vascular endothelial function in patients with type 2 diabetes","volume":"12","author":"Ando","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_63","first-page":"28","article-title":"Validity of standard deviation and maximum: Minimum ratio in quantifying cardiac autonomic function following acute unilateral brachial artery occlusion","volume":"6","author":"Sheila","year":"2011","journal-title":"J. Chin. Clin. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1177\/193229681100500319","article-title":"The Effect of Type-2-Diabetes-Related Vascular Endothelial Dysfunction on Skin Physiology and Activities of Daily Living","volume":"5","author":"Petrofsky","year":"2011","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e004841","DOI":"10.1161\/JAHA.116.004841","article-title":"Effects of the Mean Amplitude of Glycemic Excursions and Vascular Endothelial Dysfunction on Cardiovascular Events in Nondiabetic Patients with Coronary Artery Disease","volume":"6","author":"Akasaka","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Marcinkevics, Z., Aglinska, A., Rubins, U., and Grabovskis, A. (2021). Remote Photoplethysmography for Evaluation of Cutaneous Sensory Nerve Fiber Function. Sensors, 21, Available online: https:\/\/www.mdpi.com\/1424-8220\/21\/4\/1272\/htm.","DOI":"10.3390\/s21041272"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Wei, H.-C., Hu, W.-R., Ta, N., Xiao, M.-X., Tang, X.-J., and Wu, H.-T. (2020). Prognosis of Diabetic Peripheral Neuropathy via Decomposed Digital Volume Pulse from the Fingertip. 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