Aims: To investigate the co-existence of diabetic peripheral neuropathy (DPN), painful diabetic peripheral neuropathy (PDPN), and cardiac autonomic neuropathy (CAN) and to establish a model to predict CAN based on peripheral measurements. Methods: Eighty participants (20 type 1 diabetes (T1DM) + PDPN, 20 T1DM + DPN, 20 T1DM-DPN (without DPN), and 20 healthy controls (HC)) underwent quantitative sensory testing, cardiac autonomic reflex tests (CARTs), and conventional nerve conduction. CAN was defined as ≥ 2 abnormal CARTs. After the initial analysis, the participants with diabetes were re-grouped based on the presence or absence of small (SFN) and large fibre neuropathy (LFN), respectively. A prediction model for CAN was made using logistic regression with backward elimination. Results: CAN was most prevalent in T1DM + PDPN (50%), followed by T1DM + DPN (25%) and T1DM-DPN and HC (0%). The differences in prevalence of CAN between T1DM + PDPN and T1DM-DPN/HC were significant (p < 0.001). When re-grouping, 58% had CAN in the SFN group and 55% in the LFN group, while no participants without either SFN or LFN had CAN. The prediction model had a sensitivity of 64%, a specificity of 67%, a positive predictive value of 30%, and a negative predictive value of 90%. Conclusion: This study suggests that CAN predominantly co-exists with concomitant DPN.

Original languageEnglish
JournalActa Diabetologica
Issue number6
Pages (from-to)777–785
Number of pages9
Publication statusPublished - Jun 2023

Bibliographical note

© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.


  • Cardiac autonomic neuropathy
  • Diabetic autonomic neuropathy
  • Diabetic foot
  • Diabetic peripheral neuropathy
  • Large fibre neuropathy
  • Neuropathic pain
  • Painful diabetic peripheral neuropathy
  • Small fibre neuropathy


Dive into the research topics of 'The co-existence of sensory and autonomic neuropathy in type 1 diabetes with and without pain'. Together they form a unique fingerprint.

Cite this