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Early detection of sub-clinical autonomic dysfunction is of vital
importance in patients with diabetes mellitus (DM) for the
prevention of subsequent serious adverse consequences. Reduction in
heart rate variability (HRV) is now regarded as the earliest
indicator of cardiovascular dysregulation in DM. HRV has
traditionally been quantified using linear measures, which describe
the magnitude of RR interval oscillations, but are insufficient to
characterise complex heart rate dynamics. While HRV is mostly
mediated by parasympathetic nervous system, beat-to-beat blood
pressure recordings may provide information regarding sympathetic
activity. A variety of novel measures has been developed to
quantify non-linear features of cardiovascular signals, providing
information on the complexity of the dynamical system involved in
the genesis of these short-term fluctuations. In this book, it is
demonstrated that novel non-linear methods are often more sensitive
to autonomic dysregulation than linear methods and therefore may
improve the diagnostic power of cardiovascular variability analysis
for cardiovascular autonomic neuropathy in DM. Our data indicate
that cardiovascular dysregulation progresses in relatively short
time frames, depending on the history of DM. Further, its
progression appears to be associated with glycemic control.
Different methods of cardiovascular variability analysis can
provide mutually independent information and therefore should be
used simultaneously for a comprehensive analysis of autonomic
dysfunction to identify patients at risk for autonomic neuropathy.
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