Relationship of the Valsalva ratio to autonomic neuropathy and other complications of diabetes mellitus.

1. The Valsalva ratios (VR) of 48 diabetic patients and 48 normal individuals matched by age and sex were compared in order to examine the relationship between VR and the prevalence and severity of retinopathy, neuropathy and nephropathy, which are chronic complications of diabetes mellitus. 2. Diabetic patients without clinical evidence of neurological damage had the same VR (1.95 +/- 0.09) as the matched control group (1.95 +/- 0.14). Diabetic patients exhibiting some evidence of diabetic neuropathy showed VR values lower than their control groups (1.58 +/- 0.07 vs. 1.81 +/- 0.7), whereas patients with symmetric sensitive polyneuropathy plus autonomic neuropathy had the lowest VR scores (1.16 +/- 0.04 vs. 1.86 +/- 0.14). 3. An inverse relationship was shown between VR and the prevalence of retinopathy and nephropathy and the duration of diabetes mellitus. Low VR values correlated well with the prevalence and severity of complications. 4. It is concluded that the Valsalva ratio is an effective indicator of autonomic neuropathy.