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Two diabetic women (case 1, 75 years old; case 2, 49 years old) being treated with glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) showed no suppression of cortisol secretion on a dexamethasone suppression test (DST). However, its secretion was suppressed after switching from GLP-1 RAs to insulin. We also checked the cortisol secretion by a DST in five consecutive inpatients (case 3-7) being treated with GLP-1 RAs. The coefficients of R-R interval variation at rest and during deep breathing were lower in the two false-positive cases (case 1 and 2) than in the five true-negative cases (case 3-6). GLP-1 RAs can be switched to insulin in order to eliminate the slow absorption effect of dexamethasone by GLP-1 RAs if a DST is planned in diabetic patients receiving GLP-1 RAs.

Autonomic diabetic neuropathy (ADN) is a complication of diabetes mellitus (DM), to which there is no specific treatment. In this study, the efficacy of the essential oil of Croton zehntneri (EOCz) in preventing ADN was evaluated in the rat vagus nerve. For the two fastest conducting myelinated types of axons of the vagus nerve, the conduction velocities and rheobase decreased, whilst the duration of the components of the compound action potential of these fibers increased. EOCz completely prevented these DM-induced alterations of the vagus nerve. Unmyelinated fibers were not affected. In conclusion, this investigation demonstrated that EOCz is a potential therapeutic agent for the treatment of ADN.

Automated identification of normal and diabetic subjects using HRV signals.Features are extracted using DWT method.Ranked features are subjected to various classifiers.Proposed method classifies diabetes and normal subjects with 92.02% accuracy. Diabetes Mellitus (DM), a chronic lifelong condition, is characterized by increased blood sugar levels. As there is no cure for DM, the major focus lies on controlling the disease. Therefore, DM diagnosis and treatment is of great importance. The most common complications of DM include retinopathy, neuropathy, nephropathy and cardiomyopathy. Diabetes causes cardiovascular autonomic neuropathy that affects the Heart Rate Variability (HRV). Hence, in the absence of other causes, the HRV analysis can be used to diagnose diabetes. The present work aims at developing an automated system for classification of normal and diabetes classes by using the heart rate (HR) information extracted from the Electrocardiogram (ECG) signals. The spectral analysis of HRV recognizes patients with autonomic diabetic neuropathy, and gives an earlier diagnosis of impairment of the Autonomic Nervous System (ANS). Significant correlations with the impaired ANS are observed of the HRV spectral indices obtained by using the Discrete Wavelet Transform (DWT) method. Herein, in order to diagnose and detect DM automatically, we have performed DWT decomposition up to 5 levels, and extracted the energy, sample entropy, approximation entropy, kurtosis and skewness features at various detailed coefficient levels of the DWT. We have extracted relative wavelet energy and entropy features up to the 5th level of DWT coefficients extracted from HR signals. These features are ranked by using various ranking methods, namely, Bhattacharyya space algorithm, t-test, Wilcoxon test, Receiver Operating Curve (ROC) and entropy.The ranked features are then fed into different classifiers, that include Decision Tree (DT), K-Nearest Neighbor (KNN), Naive Bayes (NBC) and Support Vector Machine (SVM). Our results have shown maximum diagnostic differentiation performance by using a minimum number of features. With our system, we have obtained an average accuracy of 92.02%, sensitivity of 92.59% and specificity of 91.46%, by using DT classifier with ten-fold cross validation.

Amac: Tip 2 diabetes mellituslu (DM) hastalarda gastrointestinal ve kardiyovaskuler diyabetik otonomik noropatinin degerlendirilmesi amaclanmaktadir. Materyal ve Metot: DM hastalarindan olusan calisma grubu Mart-Eylul 2012 tarihleri arasinda incelendi. Yas, vucut kutle indeksi (VKI), aclik kan glukozu, HbA1c, C-peptid, diyabet suresi, elektrokardiyogram, kan basinci, kalp hizi kaydedildi. Hastalar kontrol altinda olan ve olmayan diyabetikler olarak gruplandirildi. Kardiyak otonom noropati (KON) testleri degerlendirildi. Anal manometri ile rekto-anal inhibitor refleks, istirahat ve sikma basinclari olculdu. Bulgular: Toplam 50 DM hastasi calismaya kaydedildi ve hastalarin yas ortalamasi 57,06±8,92 yil, istirahat anal basinci ortalamasi 55,92±14,84 mmHg ve sikma anal basinci ortalamasi 83,15±31,00 mmHg idi. Orta ve agir KON gruplari arasinda istirahat anal basincinda anlamli fark saptanmazken (p=0,573), orta ve agir KON gruplari arasinda maksimum sikma basincinda anlamli fark mevcuttu (p=0,005). Kisa veya uzun sureli diyabeti olan hastalarda anal manometrik basinclarda fark saptanmadi. KON ile VKI arasinda iliski bulunmazken yas ile iliski saptandi. Kotu glisemik kontrol istirahat basinda azalma ile iliskili iken, maksimum sikma basinci ve yetersiz glisemik kontrol grubu arasinda iliski yoktu. KON’un siddeti maksimum sikma basincinda azalma ile iliskiliydi. Sonuc: Kardiyak ve gastrointestinal otonom disfonksiyon, DM’nin onemli komplikasyonlaridir. Anal manometri testleri ve KON diyabetin bu komplikasyonlarini gosterebilir.

The symptoms caused by gastrointestinal autonomic neuropathy in diabetes mellitus is important to highlight since it affects a large proportion of people with diabetes, regardless of whether this is type 1 or type 2. Gastroparesis and general signs of bowel dysfunction, such as constipation, diarrhoea and abdominal pain are most often encountered and involve both pharmacological and non-pharmacological treatment options. This mini-review summarises a presentation given at the 'Diagnosis and treatment of autonomic diabetic neuropathy in the gut' symposium at the 2015 annual meeting of the EASD. It is accompanied by another mini-review on a topic from this symposium (by Azpiroz and Malagelada, DOI: 10.1007/s00125-015-3831-1 ) and a commentary by the Session Chair, Peter Kempler (DOI: 10.1007/s00125-015-3826-y ).

Microvascular dysfunction in diabetes plays a crucial role in the development of diabetic complications. The skin, as one of the most accessible organs, serves as a model for the investigation of microvascular dysfunction. Several non-invasive, mostly laser-Doppler-based methods have been developed lately to assess microvascular function in the skin. Microvascular functional changes occur even in the prediabetic state and become more complex with overt diabetes, being exacerbated by the presence of peripheral and/or autonomic diabetic neuropathy. The present article aims at shedding light on the implication of endothelial and neurovascular dysfunction in microvascular changes in diabetes, highlighting the contribution of different forms of diabetic neuropathy.

Assessment of the autonomic nervous system function could be of great importance in evaluation of the risk factors of the patients in perioperative period. Surgery and anaesthesia as integral medical procedures aimed as restoring and improving different disorders of homoestasis and physical conditions of subjects with different ailments and functional cardiac reserves have strong influence on haemodynamic function in perioperative period and it is of a great importance to clearly define if an individual patient is at a great risk of autonomic dysfunction in addition to the underlying morbidity, whicht increase the risk of morbidity and mortality in the perioperative period. Clinical tests for evaluation of autonomic nervous dysfunction have not become widely used by clinicians for several reasons. Some of the clinical tests are quite demanding what makes them less possible for performing in patients with poor reserve and more comorbidities and there are also difficulties in interpretation of subjective findings. Monitoring of heart rate variability as a parameter of autonomic nervous system activity has been clearly advocated in the risk assessment and follow up of the patients who develop diabetes mellitus and patients with coronary syndrome [1]. In subjects with diabetes mellitus who could have cardiac autonomic diabetic neuropathy, the quite serious condition of haemodynamic instability could increase the risk of aggravation and complications of the general condition in perioperative period [2]. On the other hand, most subjects with different stages of coronary syndrome have been shown to have different alterations of heart rate variability, and monitoring of heart rate viability in perioperative period could be a part of predicting tools of risk factors for surgery and anaesthesia [3]. The aim of this paper to give a reviewi of the importance of assessment of heart rate variability in relatively healthy subjects and subjects with different comorbid states, focusing on presenting of different findings of linear meaures of the analysis of parameter by means of two different softwares. Figure 1. Tachogram during calm and deep respiration in relatively healthy subject

Autonomic diabetic neuropathy is a common and serious complication of diabetes mellitus with variable multiple organ involvement, principally of the cardiovascular system, but also of the gastrointestinal and urogenital tracts ([1][1]). Cardiac autonomic neuropathy (CAN) causes alterations in heart

The possibility recently offered by computer techniques for quantifying the small spontaneous beat-by-beat oscillations characterizing the cardiovascular variables and in particular the electrocardiographic R-R intervals aroused a growing interest in view of the hypothesis that these rhythmical oscillations could provide some insight into the neural regulatory mechanisms operating in the intact organism under various real-life conditions.