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Cardiac autonomic function in children with type 1 diabetes

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Abstract

Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D). This study aimed to evaluate cardiac autonomic nervous system (ANS) function in children with T1D and its relation to different demographic, clinical and laboratory variable. This cross-sectional study included 60 children with T1D (mean age = 15.1 ± 3.3 years; duration of diabetes = 7.95 ± 3.83 years). The following 8 non-invasive autonomic testing were used for evaluation: heart rate at rest and in response to active standing (30:15 ratio), deep breathing and Valsalva maneuver (indicating parasympathetic function); blood pressure response to standing (orthostatic hypotension or OH), sustained handgrip and cold; and heart rate response to standing or positional orthostatic tachycardia syndrome or POTs (indicating sympathetic function). None had clinically manifest CAN. Compared to healthy children (5%), 36.67% of children with T1D had ≥ 2 abnormal tests (i.e., CAN) (P = 0.0001) which included significantly abnormal heart rate response to standing (POTs) (P = 0.052), active standing (30:15 ratio) (P = 0.0001) and Valsalva maneuver (P = 0.0001), indicating parasympathetic autonomic dysfunction, and blood pressure response to cold (P = 0.01), indicating sympathetic autonomic dysfunction. 54.55, 27.27 and 18.18% had early, definite and severe dysfunction of ANS. All patients had sensorimotor peripheral neuropathy. The longer duration of diabetes (> 5 years), presence of diabetic complications and worse glycemic control were significantly associated with CAN.

Conclusions: The study concluded that both parasympathetic and sympathetic autonomic dysfunctions are common in children with T1D particularly with longer duration of diabetes and presence of microvascular complications.

What is Known:

• Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D).

• Limited studies evaluated CAN in children with T1D.

What is New:

• CAN is common in children with T1D.

• Cardiac autonomic functions should be assessed in children with T1D particularly in presence of microvascular complications.

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Abbreviations

ANS:

Autonomic nervous system

CAN:

Cardiac autonomic neuropathy

HRV:

Heart rate variability

DAN:

Diabetic autonomic neuropathy

DBP:

Diastolic blood pressure

OH:

Orthostatic hypotension

POTs:

Positional orthostatic tachycardia syndrome

r-MSSD:

Root mean square of successive differences

SBP:

Systolic blood pressure

pNN50:

The percentage of differences between adjacent normal RR intervals > 50 ms

T1D:

Type 1 diabetes

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt

    Kotb Abbass Metwalley & Hekma Saad Farghaly

  2. Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt

    Sherifa Ahmed Hamed

Authors
  1. Kotb Abbass Metwalley
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  2. Sherifa Ahmed Hamed
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  3. Hekma Saad Farghaly
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Contributions

KAM participated in the design of the protocol of the study, coordination of the research, performance of the clinical part, analyses of the data, and writing the draft of the paper. SAH participated in the design of the protocol of the study, participated in the analyses of the data and writing the draft of the paper. HSF participated in the design of the protocol of the study, coordination of the research, performance of the clinical part and writing the draft of the paper. All the authors read and approved the manuscript.

Corresponding author

Correspondence to Hekma Saad Farghaly.

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Conflict of interest

All authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Ethical approval

The study protocol was approved by the Ethics Committee of Faculty of Medicine, Assiut Children University Hospital, Assiut, Egypt.

Informed consent

Written informed consents were obtained from the parents of all participants.

Additional information

Communicated by Peter de Winter

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Metwalley, K.A., Hamed, S.A. & Farghaly, H.S. Cardiac autonomic function in children with type 1 diabetes. Eur J Pediatr 177, 805–813 (2018). https://doi.org/10.1007/s00431-018-3122-1

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  • DOI: https://doi.org/10.1007/s00431-018-3122-1

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