Cardiovascular autonomic neuropathy increases morbidity and mortality, and reduces quality of life and activities of daily living of the patients with diabetes. The reduced cardiovascular autonomic function as measured by heart rate variability is strongly associated with an increased risk of silent myocardial ischemia and mortality. Currently, no specific therapeutic strategies can be recommended for cardiac autonomic neuropathy, but management of hyperglycemia and the use of angiotensin-converting enzyme inhibitors and beta blockers should be instituted.