Diabetic Cardiovascular Autonomic Neuropathy (CAN) is a serious complication of diabetes, affecting one-fourth of type 1 and one-third of type 2 diabetic patients. It involves damage to the autonomic nerves that control heart rate and blood vessel function, leading to abnormalities such as resting tachycardia, orthostatic hypotension, exercise intolerance, and increased risk of mortality. CAN can also lead to silent myocardial ischemia and silent myocardial infarction, contributing to higher mortality rates. The prevalence of CAN varies widely due to differences in methodology and lacks standardization, ranging from 1% to 90%. Risk factors for CAN include age, duration of diabetes, poor glycemic control, obesity, and smoking. The clinical manifestations of CAN include resting tachycardia, exercise intolerance, orthostatic hypotension, and increased intraoperative cardiovascular instability. Orthostatic hypotension, characterized by a drop in blood pressure upon standing, can be disabling and is often misjudged as hypoglycemia. Exercise intolerance in diabetic patients with CAN is due to impaired parasympathetic and sympathetic responses, reduced ejection fraction, and decreased diastolic filling. Intraoperative management of patients with CAN is crucial due to higher cardiovascular morbidity and mortality, with frequent need for BP support and increased risk of hypothermia and impaired ventilatory drive. Diagnostic assessments of CAN include cardiovascular autonomic reflex tests, 24-hour heart rate variability (HRV), spontaneous baroreflex sensitivity, and cardiac radionuclide imaging. These tests help identify early stages of CAN and guide therapeutic interventions. Treatment options for CAN include lifestyle modifications, medications such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, and intensive glycemic control. Studies have shown that improving glycemic control and managing multiple risk factors can reduce the incidence and progression of CAN, improving outcomes and reducing mortality. In conclusion, CAN is a significant complication of diabetes that can lead to severe clinical outcomes. Early diagnosis and management are essential to improve patient outcomes and reduce the risk of premature mortality.Diabetic Cardiovascular Autonomic Neuropathy (CAN) is a serious complication of diabetes, affecting one-fourth of type 1 and one-third of type 2 diabetic patients. It involves damage to the autonomic nerves that control heart rate and blood vessel function, leading to abnormalities such as resting tachycardia, orthostatic hypotension, exercise intolerance, and increased risk of mortality. CAN can also lead to silent myocardial ischemia and silent myocardial infarction, contributing to higher mortality rates. The prevalence of CAN varies widely due to differences in methodology and lacks standardization, ranging from 1% to 90%. Risk factors for CAN include age, duration of diabetes, poor glycemic control, obesity, and smoking. The clinical manifestations of CAN include resting tachycardia, exercise intolerance, orthostatic hypotension, and increased intraoperative cardiovascular instability. Orthostatic hypotension, characterized by a drop in blood pressure upon standing, can be disabling and is often misjudged as hypoglycemia. Exercise intolerance in diabetic patients with CAN is due to impaired parasympathetic and sympathetic responses, reduced ejection fraction, and decreased diastolic filling. Intraoperative management of patients with CAN is crucial due to higher cardiovascular morbidity and mortality, with frequent need for BP support and increased risk of hypothermia and impaired ventilatory drive. Diagnostic assessments of CAN include cardiovascular autonomic reflex tests, 24-hour heart rate variability (HRV), spontaneous baroreflex sensitivity, and cardiac radionuclide imaging. These tests help identify early stages of CAN and guide therapeutic interventions. Treatment options for CAN include lifestyle modifications, medications such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, and intensive glycemic control. Studies have shown that improving glycemic control and managing multiple risk factors can reduce the incidence and progression of CAN, improving outcomes and reducing mortality. In conclusion, CAN is a significant complication of diabetes that can lead to severe clinical outcomes. Early diagnosis and management are essential to improve patient outcomes and reduce the risk of premature mortality.