Most diabetes clinics run a familiar annual checklist: a retinal exam for retinopathy, a urine albumin test for nephropathy, a monofilament exam for peripheral neuropathy. Cardiac Autonomic Neuropathy — CAN, damage to the nerves regulating heart rate and vascular tone — rarely makes that list, even though it's one of diabetes's more consequential complications, and one of the few that's genuinely quick to screen for.

Why CAN gets left off the checklist

Part of it is awareness — CAN doesn't have an equivalent to a fundus photo or a monofilament kit sitting on every clinic shelf. Part of it is that dedicated autonomic testing equipment has historically been expensive, bulky, or confined to specialist neurology labs. The result is that a complication strongly linked to cardiovascular mortality in diabetic patients often goes unscreened until a patient presents with symptoms — by which point it may already be advanced.

A 5-minute addition to the annual work-up

NIBRA-CS®'s Short Test is built specifically for this gap. It's a single passive 5-minute HRV (heart rate variability) recording — no active manoeuvres, no BP cuff, no Valsalva assembly, no handgrip dynamometer. The patient simply rests quietly while the recording runs, which makes it realistic to add to a routine diabetes review without disrupting clinic flow.

The Short Test produces a 3-page report covering HRV status in 5 minutes plus prep time — versus 19 minutes plus prep for the Full Test Battery. If the HRV screen flags a reduced result, the patient can be brought back for the Full Test Battery, which adds Ewing's five reflex tests to reach a complete Normal / Early / Definite / Severe CAN classification.

Who it's for

  • Newly diagnosed Type 2 patients — establishing a baseline early, before autonomic changes have had years to develop.
  • Long-duration diabetics (10+ years) — the population where CAN prevalence rises sharply and annual screening has the most value.
  • Patients being evaluated for surgery — CAN is a recognised predictor of perioperative cardiovascular instability, making it relevant to pre-anaesthesia risk assessment, not just endocrinology follow-up.
  • Patients who can't safely perform active manoeuvres — the Short Test's passive recording works where Valsalva or standing tests may not be appropriate.

Built for clinic throughput, not just research

NIBRA-CS® is a CDSCO Class B (MD5) licensed medical device, not a research instrument — the on-screen instructions guide the operator through the recording directly, and the automated report is formatted for inclusion in the patient's file without manual scoring. It's already deployed commercially at RIMS Ranchi and has been used in clinical validation and pilot studies at AIIMS Kalyani, JIMS Budge Budge, and IIMC Sonarpur.

See how the Short Test fits into a diabetes screening workflow

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