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）是糖尿病的严重并发症，死亡风险增加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，并与显著的发病率相关，但DAN的重要性尚未得到充分认识，并且经常未被诊断。其中一个主要原因是，虽然严重的症状性DAN相对罕见，但许多人患有亚临床或无症状的DAN。这种疾病的早期检测可能会导致糖尿病患者更好的预后，通过部署干预措施，这将减缓甚至可能逆转其进展。然而，与其他微血管并发症不同，目前还没有简单的测试或生物标志物可以筛查大量人群。它还限制了对疾病自然史的研究以及大规模前瞻性试验中干预措施的影响。心率变异性的动态瞳孔描记术和频谱分析是安全、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，这些方法可以作为不同类型和阶段的自主神经病变的新生物标志物。这项横断面研究的目的是通过比较这些不同技术与标准心血管反射试验评估自主神经病变的有效性。它将包括5组（每组n=20），包括：糖尿病患者和（1）症状性自主神经病变;（2）无症状性自主神经病变;（3）亚临床自主神经病变;（4）无自主神经病变和（5）健康志愿者。此外，对结果的分析将提供所研究的不同组受试者之间的分析参数的变化范围，并允许这些技术的改进和标准化。

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.