Background: Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia. Complex combinations between environmental and genetic factors cause various types of diabetes mellitus. Complications from diabetes mellitus, such as cardiac autonomic neuropathy, are common. Unbalanced autonomic function, which manifests as cardiac autonomic neuropathy, is a significant predictor of cardiovascular events in the diabetic patients.

Objectives: To study the prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus with peripheral neuropathy in a tertiary care teaching hospital.

Methodology: Observational Cross-sectional hospital-based study done in 131 type 2 diabetes mellitus patients who presented to the General Medicine outpatient and inpatient departments of a tertiary care teaching hospital of central Kerala from December 2020 to April 2022. The data was entered in MS excel sheet and was analyzed using SPSS software.

Results: In the present study the mean age was 62.24 years. Among participants, 96.2% had HbA1c levels above 6.5%. Mean duration of living with diabetes is13.40 years. We observed that 65.6% of the patients in our study population had Cardiac autonomic neuropathy. Despite having peripheral neuropathy, 34.4% of participants exhibited normal cardiac sympathetic and parasympathetic function.