Cardiovascular Autonomic Neuropathy (CAN) is one of the most overlooked complications of DM and is clinically important because of its life threatening consequences. CAN results from damage to the autonomic nerve fibers that innervate the heart and blood vessels and it causes abnormalities in control of heart rate and vascular dynamics .The present study was designed to assess the cardiovascular autonomic function in type 2 DM. The cardiovascular autonomic function have been conducted in 30 cases of type II DM and 30 controls, aged between 30-50 years, Including both genders, by using Deep breathing test (DBT), Valsalva Maneuvre (VM), Cold Pressor Test (CPT), Lying to standing test (LST) and its correlation with duration of diabetes. The duration of DM was negatively correlated with delta heart rate (-0.908), valsalva ratio (-0.926), rise in diastolic pressure during hand grip test (– 0.747) and cold pressor test (-0.888). From this study it is concluded that, the duration of diabetes has more effect of CAN.

Under conditions of stress of either physical or psychological origin, there is activation of SNS. The cold pressor response which consists of placing the hand in cold water acts as a painful stimulus and has been used to study the autonomic response. In cold-pressor test, an increase in the SBP by 10-20 mm of Hg and DBP by 10mm ofHg is considered as a normal response. The afferent fibers for this response are the somatic fibers carrying the pain sensation, which are stimulated by placing the hand in cold water, and efferent are the sympathetic fibers. In our study the difference in SBP and DBP values is less in diabetics as compared with controls. The difference in DBP difference values are statistically significant .The possible explanation for this pattern of autonomic nervous dysfunction is the presence of long axons in cardiac parasympathetic systems, which are relatively more sensitive to the metabolic derangement as compared to the relatively short axons in cardiac sympathetic nerves.

The major limitation of the present study is less sample size. Also, we have not studied the newly diagnosed diabetics. In our future studies, we plan to assess the CAN by in newly diagnosed patients also. The autonomic activity measured in this study is not very accurate. Therefore, future studies should include more accurate methods of assessment of sympathetic activity such as estimation of plasma catecholamine or metabolites of catecholamine in urine like Vanillylamandelic acid (VMA), Metanephrine, and Normetanephrine.

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