Diabetic autonomic neuropathy

The diabetic autonomic neuropathy is a poorly studied subject in our medical literature. This study is aimed at investigating the presence of diabetic autonomic neuropathy in a group of Sudanese diabetic patients and its relationship to factors like glycemic control, duration of diabetes and presence of peripheral neuropathy. During one year we examined 120 diabetic patients and an age-matched control group of 42 by applying a battery of 5 cardiovascular autonomic tests, beside a full history and clinical examination. The patients were also tested for glycemic control and presence of peripheral neuropathy. Diabetic autonomic neuropathy was diagnosed in 48 patients [40%] of a mean age of 48.411 + 12.50 years, type 1/2 diabetes was 10/38, mean duration of diabetes 16.2 + 7.3 years, 41 with poor glycemic control [81%] and peripheral neuropathy was present in 32 patients [66%]. We found a significant association between diabetic autonomic neuropathy and prolonged duration of diabetes [P<0.001], poor glycemic control [0.01>P>0.001] and presence of peripheral neuropathy [0.02>P>0.01]. Diabetic autonomic neuropathy [both asymptomatic and symptomatic] is a common problem among our diabetic patients. It is significantly associated with prolonged duration, poor control of diabetes and presence of peripheral neuropathy. We need to augment the awareness of diabetes care providers to the occurrence, and peculiar features and tests of this syndrome

Gastroparesis diabeticorum: a clinical study in sudanese patients

Gastroparesis diabeticorum is a distressing and little mentioned gastrointestinal complication among our diabetic patients. The objective of this study was to confirm the occurrence of this syndrome and to identify its clinical features and impact on glycemic control of diabetes mellitus. The authors set a special clinic in Medani, Sudan, to receive the diabetic patients complaining of chronic [more than two weeks] symptoms related to the upper gastrointestinal tract. The criteria of diagnosis of gastroparesis diabeticorum were: symptoms [nausea, vomiting, epigastric discomfort and feeling of fullness for long periods after meals] in patients with diabetic autonomic neuropathy, and confirmatory findings of gastric stasis in the barium studies. The similar conditions were excluded. Fasting blood glucose was measured to assess the glycemic control of diabetes. Eight patients were identified, of a wide range of age group [27 - 64 years], longstanding diabetes [8 - 26 years] and poor glycemic control [fasting blood glucose > 8 mmol / L in 7 out of 8 patients]. More than one diabetic complication was recorded in each patient. We established the occurrence of gastroparesis diabeticorum as one of the manifestations of diabetic autonomic neuropathy among our patients. It should be thought of as one of the etiological factors of the upper gastroenteropathies, like peptic ulcer and giardiasis, in Sudanese diabetic patients