Diabetes Metab J.  2015 Dec;39(6):461-467. 10.4093/dmj.2015.39.6.461.

Morphologic Changes in Autonomic Nerves in Diabetic Autonomic Neuropathy

• Jin HY
• Baek HS
• Park TS

• KMID: 2173997
• DOI: http://doi.org/10.4093/dmj.2015.39.6.461

Abstract

Diabetic neuropathy is one of the major complications of diabetes, and it increases morbidity and mortality in patients with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Because the autonomic nervous system, for example, parasympathetic axons, has a diffuse and wide distribution, we do not know the morphological changes that occur in autonomic neural control and their exact mechanisms in diabetic patients with diabetic autonomic neuropathy (DAN). Although the prevalence of sympathetic and parasympathetic neuropathy is similar in T1DM versus T2DM patients, sympathetic nerve function correlates with parasympathetic neuropathy only in T1DM patients. The explanation for these discrepancies might be that parasympathetic nerve function was more severely affected among T2DM patients. As parasympathetic nerve damage seems to be more advanced than sympathetic nerve damage, it might be that parasympathetic neuropathy precedes sympathetic neuropathy in T2DM, which was Ewing's concept. This could be explained by the intrinsic morphologic difference. Therefore, the morphological changes in the sympathetic and parasympathetic nerves of involved organs in T1DM and T2DM patients who have DAN should be evaluated. In this review, evaluation methods for morphological changes in the epidermal nerves of skin, and the intrinsic nerves of the stomach will be discussed.

Keyword

Autonomic neuropathy; Autonomic pathways; Diabetes; Morphology

MeSH Terms

Autonomic Nervous System
Autonomic Pathways*
Axons
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 2
Diabetic Neuropathies*
Humans
Mortality
Prevalence
Skin
Stomach

Figure

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  Fig. 1 Structure of autonomic nervous system (ANS). CNS, central nervous system; PNS, peripheral nervous system; INS, intrinsic nervous system.

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  Fig. 2 Diabetic rat gastric mucosal layer change in human and animal models by the protein gene product 9.5 positive fibers. (A) rat control, (B) human control, (C) rat diabetes mellitus (DM), and (D) human DM. (C, D) Arrows indicated the gastric mucosal nerve degeneration of rat DM model and human DM.

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