Figure 1: Epalrestat as aldose reductase inhibitor (ARI); CVN, cardiac vagal neuropathy as cardiac autonomic neuropathy (CAN); Sitagliptin, DPP-4 inhibitor as incretin-based therapy (IBT). The “n” shows the number of analyzed patients with CVN and type 2 diabetes mellitus in this study Group A (n= 12) with CVN before treatment was treated with add-on 150 mg/day of oral epalrestat alone as ARI, group B (n= 18) with CVN before treatment was treated with add-on 50 mg/day of oral sitagliptin alone as IBT, and group C (n= 12) with CVN despite treatment with add-on oral epalrestat alone (n = 6) as placebo in group A, oral sitagliptin alone (n= 5) in group B and GLP-1 receptor agonist (n = 1) as IBT for 1 year was treated with add-on combined oral epalrestat and oral sitagliptin. No diabetic patients with CVN have serviced.