Gastrointestinal, genitourinary, and neurovascular disturbances in diabetes

The gastrointestinal, genitourinary, and neurovascular systems are frequent targets of the autonomic complications of diabetes. Complications effecting these systems contribute greatly to the morbidity, mortality, and reduced quality of life and activities of daily living of the person with diabetes. They are also the major source of increased costs of caring for the diabetic patient. Impairments range from functional disturbances related to hyper- or hypoglycemia and age, duration of diabetes, and quality of diabetes control and evolve into organic disorders with loss of parasympathetic, sympathetic, and neuropeptidergic nerves. Factors in the pathogenesis are metabolism, vascular insufficiency, loss of growth factor trophism, and autoimmune destruction of smell unmyelinated nerves (C fibers) in a visceral and cutaneous distribution. The clinical manifestations range from anorexia, nausea, vomiting, brittle diabetes, diarrhea, constipation, loss of bladder control, and erectile dysfunction to impaired skin blood flow responses to heating and cooling, nociception, and gravity, with loss of amplitudes of vascular oscillation and premature aging of the neurovascular system. The disordered skin blood flow is a major factor in the development of foot ulcers and amputations. Treatments are limited to symptoms; algorithms for the many facets of these disorders are provided here, including one for gastrointestinal abnormalities and another for erectile dysfuction, Ultimately, treatment directed at the underlying pathogenic mechanisms of these manifestations is sorely needed.