Can dynamic pupillography and/or spectral analysis of heart rate variability prov

描述（由申请人提供）：糖尿病自主神经病变（DAN）是糖尿病的一种严重并发症，其死亡率增加了5倍。这种高死亡率在很大程度上与无症状心肌缺血、心律失常和心肺不稳定有关。尽管它与心血管死亡风险增加有关，并与显著发病率相关，但DAN的重要性尚未得到充分认识，并且经常未被诊断出来。造成这种情况的一个主要原因是，虽然严重的症状性DAN相对罕见，但许多人有亚临床或无症状性DAN。通过采取干预措施，及早发现这种疾病，可能会减缓甚至逆转其进展，从而为糖尿病患者带来更好的预后。然而，与其他微血管并发症不同的是，目前还没有简单的测试或生物标志物可以对大量人群进行筛查。这也限制了对这种疾病的自然历史的研究以及在大规模前瞻性试验中干预措施的影响。动态瞳孔成像和心率变异性光谱分析是安全、无创、快速和简单的技术，可以在研究和临床环境中更广泛地评估和早期检测自主神经功能障碍。它们产生了各种不同的测量方法，可以作为自主神经病变不同类型和阶段的新型生物标志物。本横断面研究的目的是通过将这些不同技术与标准心血管反射试验进行比较来评估自主神经病变的有用性。它将包括5组（n=20），包括：糖尿病患者和(1)症状性自主神经病变；(2)无症状自主神经病变；(3)亚临床自主神经病变；(4)无自主神经病变；(5)健康志愿者。此外，对结果的分析将提供所分析参数在不同研究对象组之间的变化范围，并允许对这些技术进行改进和标准化。

DESCRIPTION (provided by applicant): Diabetic autonomic neuropathy (DAN) is a serious complication of diabetes and carries up to a five-fold increased risk of mortality. This high mortality rate is related in large part to silent myocardial ischemia, cardiac arrhythmias, and cardio-respiratory instability. Despite its relationship to an increased risk of cardiovascular mortality and its association with significant morbidity, the importance of DAN is not fully appreciated and it frequently goes undiagnosed. A major reason for this is that whilst severe symptomatic DAN is relatively uncommon, many people have sub-clinical or asymptomatic DAN. Early detection of this disorder might lead to a better prognosis for people with diabetes, by the deployment of interventions which will slow or possibly even reverse its progression. However, unlike other microvascular complications, there is currently no simple test or biomarker that would allow for screening large numbers of people. It has also limited the study of the natural history of the disorder and the impact of interventions in large-scale prospective trials. Dynamic pupillography and spectral analysis of heart rate variability are safe, noninvasive, quick and easy techniques that may allow for more widespread assessment and earlier detection of autonomic dysfunction both in the research and clinical setting. They result in a variety of different measures that may act as novel biomarkers for different types and stages of autonomic neuropathy. The aim of this cross-sectional study is to assess the usefulness of these different techniques by comparing them with standard cardiovascular reflex tests for the assessment of autonomic neuropathy. It will comprise of 5 groups (n=20 in each) consisting of: people with diabetes and (1) symptomatic autonomic neuropathy; (2) asymptomatic autonomic neuropathy; (3) sub-clinical autonomic neuropathy; (4) no autonomic neuropathy and (5) healthy volunteers. Also, analysis of the results will provide the range of variation for the analysed parameters among the different groups of subjects studied and allow for refinement and standardisation of these techniques.