Whilst many patients are aware of the microvascular complications of diabetes – eyes, kidneys, peripheral nerves etc, the Cinderella complication, diabetic autononomic neuropathy (DAN) tends to affect significant numbers of patients who are either unaware of the problem or ascribe their symptoms to another condition. At the same time, as it is not regularly screened for as part of routine care, it is not until the patient has significant and often debilitating symptoms that it starts to receive attention. A sub type of the peripheral neuropathies, and depending on which methodology is used, its prevalence varies between 16-35% of patients. The ubiquitous nature of the autonomic nervous system renders virtually all organs susceptible to autonomic dysfunction but tend to fall into several groups with associated symptoms:

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It is widely recognised that the tsunami of obesity is closely followed by one of Type 2 diabetes with its associated impact on the population and health services, specifically heart disease, obstructive sleep apnoea (OSA), certain types of cancer and a decreased life expectancy.

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