Harthmann_2014_Diabet.Med_31_761

Cardiovascular autonomic neuropathy is a reversible, serious and frequent complication in diabetes mellitus [1], presenting with reduced vagal modulation to the sinus node and beat-to-beat heart rate variability [2]. Alterations in the adrenergic and/or muscarinic receptor functions with a reduction in acetylcholine release [3] may be involved in this pathogenic process. Pyridostigmine bromide, an acetyl cholinesterase inhibitor, produces cholinergic stimulation by preventing the hydrolysis of acetylcholine and increasing its availability in the synaptic cleft [4].