REVIEW Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy * V. Spallone a, *, F. Bellavere b , L. Scionti c , S. Maule d , R. Quadri e , G. Bax f , P. Melga g , G.L. Viviani h , K. Esposito i , R. Morganti a , P. Cortelli j , On behalf of the Diabetic Neuropathy Study Group of the Italian Society of Diabetology a Endocrinology, Department of Internal Medicine, Tor Vergata University, via Montpellier, 1, 00133 Rome, Italy b Villa Salus Hospital, Venezia-Mestre, Italy c Department of Internal Medicine, University of Perugia, Perugia, Italy d Autonomic Unit and Hypertension Unit, Department of Medicine and Experimental Oncology, S. Giovanni Battista Hospital, University of Turin, Turin, Italy e S. Vito Hospital, University of Turin, Turin, Italy f Servizio di Diabetologia e Dietetica, Complesso Socio-Sanitario ai Colli, Padua, Italy g Department of Endocrine and Metabolic Sciences, University of Genoa, Genoa, Italy h Department of Internal Medicine, University of Genoa, Genoa, Italy i Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy j Department of Neurological Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Received 28 January 2010; received in revised form 2 June 2010; accepted 14 July 2010 KEYWORDS Cardiovascular tests; Diagnosis; Diabetic neuropathy; Autonomic testing; Orthostatic hypotension Abstract Despite its prevalence, clinical and prognostic impact, diabetic autonomic neurop- athy, is widely under-diagnosed. The need for training and expertise to perform the cardiovas- cular tests (usually the task of diabetologists) is one possible reason. The availability of computer-assisted systems has allowed a wider diffusion of testing, but has also highlighted the need for an adequate knowledge of physiopathological backgrounds for their correct appli- cation and interpretation. The recommendations presented here were developed by the Neuropathy Study Group of the Italian Society of Diabetology and then endorsed by the Italian Association for the Study of Neurovegetative System, to promote the widespread adoption of good clinical practice in diabetic cardiovascular autonomic testing by outlining main evidence- based aspects, i.e. which tests, how to perform them, adequate interpretation of the results and their diagnostic use, confounding conditions that can impact on tests reliability. There- fore, these recommendations include the essential aspects of the physiopathological substrate * Endorsed by the Italian Association for the Study of the Neurovegetative System. * Corresponding author. Tel./fax: þ39 06 20902787. E-mail address: vispa@mclink.it (V. Spallone). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/nmcd Nutrition, Metabolism & Cardiovascular Diseases (2011) 21, 69e78 0939-4753/$ - see front matter ª 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.numecd.2010.07.005