563-P: Autonomic Neuropathy in Type 1 Diabetes (T1D): Findings from the T1D Exchange
Authors: MIZOKAMI-STOUT KARA R. , BAILEY RYAN , FOSTER NICOLE C. , ANG LYNN , ALEPPO GRAZIA , LEVY CAROL J. , RICKELS MICHAEL R. , SHAH VIRAL N. , POLSKY SARIT , KATZ MICHELLE , NELSON BRYCE A. , CARLSON ANDERS , VENDRAME FRANCESCO , POP-BUSUI RODICA 
Published: June 2019

Diabetic autonomic neuropathy (DAN) may contribute to significant morbidity, including orthostatic hypotension, arrhythmia, hypoglycemia unawareness, gastroparesis, enteropathy, urinary incontinence and sexual dysfunction in T1D. Contemporary data on DAN impact are scarce. We evaluated the frequency of DAN in adult T1D patients enrolled in the T1D Exchange Clinic Network using the validated Survey of Autonomic Symptoms (SAS). Surveys were emailed to registry participants who consented to be emailed about future studies. DAN was defined as a score &gt;3 on the Symptom Score (SS). Severity of symptoms was graded with the Total Impact Score (TIS) defined as mild (≤25th percentile), moderate (≤50th percentile) and severe (≤75th percentile). Multivariable linear regression and stepwise logistic regression were used to analyze SAS-defined DAN and the correlations between DAN and glycemic control, medical comorbidities and socioeconomic factors. Among 965 T1D participants, DAN frequency was 17%, of which 76% presented with moderate and 24% with severe symptoms. Participants with DAN were older (44±16 vs. 39±17 years), were more often female (73% vs. 62%), had longer T1D duration (28±14 years vs. 23±14 years), and had higher hemoglobin A1c (8.1±1.7% vs. 7.7±1.5%) than those without DAN (all p-values &lt;0.05). Compared with those without DAN, those with DAN were more likely to have peripheral neuropathy (OR 8.10, 95% CI 4.57-14.18), gastroparesis (OR 5.35, 95% CI 2.55-11.23), cardiovascular disease (OR 2.60, 95% CI 1.34-4.91), depression (OR 2.20, 95% CI 1.46-3.32) and use opioids (OR 4.23, 95% CI 1.76-10.13), both p-values &lt;0.01. As ascertained by the short SAS questionnaire, we found that DAN symptoms were common and should be screened for regularly. Traditional glycemic risk factors and the presence of peripheral neuropathy and CVD were associated with DAN. Opioid use also was greater in those with DAN, which might serve as a marker of more painful peripheral neuropathy.

Disclosure
K.R. Mizokami-Stout: None. R. Bailey: None. N.C. Foster: None. L. Ang: None. G. Aleppo: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Dexcom, Inc., Medtronic MiniMed, Inc. Research Support; Self; AstraZeneca, Dexcom, Inc., Lilly Diabetes, Novo Nordisk Inc. C.J. Levy: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Allergan. M.R. Rickels: None. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. S. Polsky: Consultant; Self; Jaeb Center for Health Research. Research Support; Self; Barbara Davis Center for Diabetes, Children's Diabetes Foundation, Dexcom, Inc., Eli Lilly and Company, JDRF, Leona & Harry Helmsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US. M. Katz: None. B.A. Nelson: None. A. Carlson: Consultant; Self; Sanofi US. Research Support; Self; Abbott, Dexcom, Inc., JDRF, Medtronic, National Institutes of Health, Novo Nordisk A/S. F. Vendrame: None. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust