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

描述(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，死亡风险增加五倍。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DAN与心血管死亡的风险增加有关，也与显著的发病率有关，但DAN的重要性并未得到充分认识，而且经常被漏诊。一个主要原因是，虽然严重的症状性DAN相对较少见，但许多人都有亚临床或无症状的DAN。及早发现这种疾病可能会通过部署干预措施来减缓甚至可能逆转其进展，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，目前还没有简单的检测或生物标志物来筛查大量的人。它还限制了对这种疾病的自然历史和大规模前瞻性试验中干预措施的影响的研究。动态瞳孔描记和心率变异性频谱分析是安全、非侵入性、快速和简单的技术，可以在研究和临床环境中对自主神经功能障碍进行更广泛的评估和更早的检测。它们导致了各种不同的措施，可以作为不同类型和不同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将这些不同的技术与评估自主神经病变的标准心血管反射测试进行比较来评估它们的有效性。它将由5组人组成，每组20人，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的参数在不同研究对象组之间的变化范围，并允许改进和标准化这些技术。

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.