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Cardiac Autonomic Neuropathy in the Diabetic Patient: Does ¹²³I-MIBG Imaging Have a Role to Play in Early Diagnosis?

School of Medical Radiation Sciences, University of Sydney, New South Wales, Australia

Objectives: In diabetes, extended adrenergic receptor stimulation with hyperglycemia and insulin deficiency is associated with cardiac autonomic dysfunction. Clinically evident diabetic cardiac autonomic neuropathy (CAN) is associated with a poor prognosis. Research studies indicate that autonomic function tests, which are traditionally used to diagnose diabetic CAN, are less sensitive than ¹²³I-metaiodobenzylguanidine (MIBG) imaging, particularly in the early stages of the disease. This established imaging technique makes use of the noradrenaline analog MIBG, which is radiolabeled with ¹²³I to assess the noradrenaline uptake-1 mechanism of the sympathetic nervous system. Although scintigraphic studies indicate that long-standing cardiac autonomic dysfunction is permanent, some authors have shown partial reversibility with early metabolic intervention. ¹²³I-MIBG imaging could therefore have an important clinical role to play in the early diagnosis and treatment monitoring of diabetic CAN.

Methods: A PubMed/MEDLINE Internet search was performed using MIBG, diabetes, and cardiac autonomic neuropathy as key words.

Conclusion: The general expense of ¹²³I-MIBG imaging, together with the lack of commercial availability of this radiopharmaceutical in the United States, has limited the clinical use of this technique. As such, the clinical role of ¹²³I-MIBG imaging in the early diagnosis of diabetic CAN has yet to be validated and defined in most regions of the world, and further study is required.

Key Words: diabetes; cardiac autonomic neuropathy; ¹²³I-metaiodobenzylguanidine; MIBG