Vol. 6, Issue 2, Part A (2024)

Cardiovascular autonomic neuropathy (CAN) is a significant complication in patients with type 2 diabetes mellitus (T2DM), closely linked to disease duration, microvascular complications, insulin resistance, and inflammatory cytokines (Homa-IR). The inhibition of catecholamine-induced pathways has been shown to lower blood glucose levels while potentiating acetylcholine across various species, including humans, rats, and monkeys. Short-acting nitrates are recommended as first-line therapy for chronic angina, offering immediate symptom relief. However, nonselective beta-blockers are contraindicated in diabetes due to their potential to obscure hypoglycemia awareness and worsen insulin resistance. Comparative studies of transdermal nitroglycerin and calcium antagonists have suggested that tailored nitroglycerin doses, combined with holistic sodium nitroprusside/nitrate therapy, may offer therapeutic benefits. Improved glycemic control, lipid management, and autonomic dysfunction can lead to better clinical outcomes in T2DM. Additionally, N2O shows promise as a next-generation therapy for CAN, potentially improving the discontinuation of second-line cardiac diabetic drugs.