One of the most serious complications of diabetes is peripheral diabetic neuropathy. Diabetes causes chronic high levels of blood sugar and failure of transporting glucose to the body cells, which in turns damages neurons and their peripheral fibers. This pathological process particularly affects peripheral neural paths of the autonomic nervous system, which is essential in regulating many body functions such as heartbeat, blood pressure, breathing, gland secretion, etc. Systematic damage of the autonomic fibers impairs the body regulation causing body dysfunctions and subsequently various secondary health conditions such as cardiovascular failure.
Therefore performing proper health assessment helps to objectively evaluate the state of the autonomic regulatory function and timely detect its failure in diabetic patients well before any clinical symptoms of diabetic neuropathy occur. Such assessments may help in preventing serious diabetic complications or at least in managing this condition.
How to evaluate the degree of diabetic autonomic dysfunction when conducting health assessment? Traditionally a special biochemical test is used for this purpose, which gives indirect way to estimate chances of having the autonomic regulatory dysfunction. This health assessment test measures the amount of glucose tied to hemoglobin in blood stream. If blood glucose level is high for a long period of time then more glucose is tied to hemoglobin. This level indicates the severity of the pathological process. It was statistically shown that the higher this level is the higher chances of having the autonomic dysfunction.
However there is a fairly simple method of health assessment of the autonomic function based on quantitative evaluation of activity of the autonomic nervous system. Special normal values must be used for adequate quantitative assessment of the autonomic function. These normal values are created by special clinical testing of a population of healthy subjects whose autonomic function is not affected.
Heart rate variability How to assess the function of the autonomic nervous system? There is one well-known simple yet effective method called heart rate variability (HRV) analysis. Our heart rhythm is under constant dynamic control of the autonomic nervous system. This heart rate variability method is based on heart rate recording and its respective mathematical analysis. As a result heart rate variability analysis gives quantitative measure of the autonomic function. The results are compared to their normal values and thus autonomic regulatory function is assessed.
Additionally there are more comprehensive HRV (heart rate variability) -based methods of health assessment utilizing challenge testing of the autonomic function such as orthostatic test, deep paced breathing, Valsalva maneuver. They all are based on using standardized provocative challenges causing specific regulatory response of the autonomic nervous system. The advantage of (heart rate variability) HRV methods is that they are capable of giving more accurate health assessments because they measure the autonomic regulatory capacity rather than its current state.
At this time one of the most effective tools for health assessment of the autonomic function is the Heart Rhythm Scanner designed and developed by a group of biomedical scientists from Biocom Technologies (USA). This tool is being successfully used by healthcare specialists and researchers in many clinics and universities of the USA and other countries.