Painful Diabetic Neuropathy Is Associated With Greater Autonomic Dysfunction Than Painless Diabetic Neuropathy

OBJECTIVE — Although a clear link between diabetic peripheral neuropathy (DPN) and autonomic neuropathy is recognized, the relationship of autonomic neuropathy with subtypes of DPN is less clear. This study aimed to investigate the relationship of autonomic neuropathy with painless and painful DPN. RESEARCH DESIGN AND METHODS — Eighty subjects (20 healthy volunteers, 20 with no DPN, 20 with painful DPN, 20 with painless DPN) underwent detailed neurophysio-logical investigations (including conventional autonomic function tests [AFTs]) and spectral analysis of short-term heart rate variability (HRV), which assesses sympathovagal modulation of the heart rate. Various frequency-domain (including low frequency [LF], high frequency [HF], and total power [TP]) and time-domain (standard deviation of all normal-to-normal R-R inter-vals [SDNN] and root mean square of successive differences [RMSSD]) parameters were assessed. RESULTS — HRV analysis revealed significant differences across the groups in LF, HF, TP, SDNN, and RMSSD (ANOVA P 0.001). Subgroup analysis showed that compared with painless DPN, painful DPN had significantly lower HF (3.59 1.08 [means SD] vs. 2.67 1.56), TP (5.73 1.28 vs. 4.79 1.51), and SDNN (2.91 0.65 vs. 1.62 3.5), P 0.05. N