Techniques for the diagnosis of diabetic autonomic neuropathy

Cardiovascular autonomic testing

Tests of predominantly parasympathetic function

Heart rate variability to deep breathing (ie, supine position with the subject breathing at a fixed rate of six breaths per minute during a six-minute period): Analyzed by the heart rate variability and the expiratory to inspiratory ratio

Tests of predominantly sympathetic adrenergic function

The beat-to-beat blood pressure response to a Valsalva maneuver (drop in phase 2, the phase 4 overshoot)

The systolic and diastolic blood pressure change in response to tilt table testing or active standing

Tests of sympathetic cholinergic function

Direct assessment of cardiac autonomic integrity by scintigraphic imaging

Gastrointestinal autonomic testing

Gastric emptying scintigraphy

Isotope-based breath test

Urologic autonomic function testing

Post-void residual

Urodynamic studies

Pupillary autonomic function testing

Pupillometry

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