Yoon Hi Cho1, Maria E Craig2, Elizabeth A Davis3, Andrew M Cotterill4, Jennifer J Couper5, Fergus J Cameron6, Paul Z Benitez-Aguirre1, R Neil Dalton7, David B Dunger8, Timothy W Jones3, Kim C Donaghue9. 1. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia. 2. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia. 3. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia. 4. Department of Paediatric Endocrinology, Mater Children's Hospital, Brisbane, Queensland, Australia. 5. Endocrinology and Diabetes Centre, Women's and Children's Hospital, and Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia. 6. Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia The University of Melbourne, Melbourne, Victoria, Australia. 7. WellChild Laboratory, St Thomas' Hospital, London, U.K. 8. University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, U.K. 9. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia kim.donaghue@health.nsw.gov.au.
Abstract
OBJECTIVE: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTS: The upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis, upper-tertile ACR was associated with faster heart rate (β = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (β = -9.5, 95% CI -18.2 to -0.8, P = 0.03), independent of age and HbA1c. CONCLUSIONS: Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lower-risk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population.
OBJECTIVE: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTS: The upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis, upper-tertile ACR was associated with faster heart rate (β = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (β = -9.5, 95% CI -18.2 to -0.8, P = 0.03), independent of age and HbA1c. CONCLUSIONS: Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lower-risk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population.
Authors: Martin Tauschmann; Janet M Allen; Malgorzata E Wilinska; Hood Thabit; Carlo L Acerini; David B Dunger; Roman Hovorka Journal: Diabetes Care Date: 2016-09-09 Impact factor: 19.112
Authors: Julie A Lovshin; Marko Škrtić; Petter Bjornstad; Rahim Moineddin; Denis Daneman; David Dunger; Heather N Reich; Farid Mahmud; James Scholey; David Z I Cherney; Etienne Sochett Journal: Am J Physiol Renal Physiol Date: 2017-12-13
Authors: Bedowra Zabeen; Maria E Craig; Sohaib A Virk; Alison Pryke; Albert K F Chan; Yoon Hi Cho; Paul Z Benitez-Aguirre; Stephen Hing; Kim C Donaghue Journal: PLoS One Date: 2016-04-06 Impact factor: 3.240
Authors: Scott T Chiesa; Marietta Charakida; Eve McLoughlin; Helen C Nguyen; Georgios Georgiopoulos; Laura Motran; Yesmino Elia; M Loredana Marcovecchio; David B Dunger; R Neil Dalton; Denis Daneman; Etienne Sochett; Farid H Mahmud; John E Deanfield Journal: Eur Heart J Date: 2019-11-14 Impact factor: 29.983
Authors: Paul Z Benitez-Aguirre; M Loredana Marcovecchio; Scott T Chiesa; Maria E Craig; Tien Y Wong; Elizabeth A Davis; Andrew Cotterill; Jenny J Couper; Fergus J Cameron; Farid H Mahmud; H Andrew W Neil; Timothy W Jones; Lauren A B Hodgson; R Neil Dalton; Sally M Marshall; John Deanfield; David B Dunger; Kim C Donaghue Journal: Diabetologia Date: 2022-02-19 Impact factor: 10.122
Authors: Martin Tauschmann; Janet M Allen; Malgorzata E Wilinska; Hood Thabit; Zoë Stewart; Peiyao Cheng; Craig Kollman; Carlo L Acerini; David B Dunger; Roman Hovorka Journal: Diabetes Care Date: 2016-01-06 Impact factor: 19.112
Authors: Timothy J Bradley; Cameron Slorach; Farid H Mahmud; David B Dunger; John Deanfield; Livia Deda; Yesmino Elia; Ronnie L H Har; Wei Hui; Rahim Moineddin; Heather N Reich; James W Scholey; Luc Mertens; Etienne Sochett; David Z I Cherney Journal: Cardiovasc Diabetol Date: 2016-02-16 Impact factor: 9.951
Authors: Adeera Levin; Evan Adams; Brendan J Barrett; Heather Beanlands; Kevin D Burns; Helen Hoi-Lun Chiu; Kate Chong; Allison Dart; Jack Ferera; Nicolas Fernandez; Elisabeth Fowler; Amit X Garg; Richard Gilbert; Heather Harris; Rebecca Harvey; Brenda Hemmelgarn; Matthew James; Jeffrey Johnson; Joanne Kappel; Paul Komenda; Michael McCormick; Christopher McIntyre; Farid Mahmud; York Pei; Graham Pollock; Heather Reich; Norman D Rosenblum; James Scholey; Etienne Sochett; Mila Tang; Navdeep Tangri; Marcello Tonelli; Catherine Turner; Michael Walsh; Cathy Woods; Braden Manns Journal: Can J Kidney Health Dis Date: 2018-01-17