Kotb Abbass Metwalley1, Sherifa Ahmed Hamed2, Hekma Saad Farghaly3. 1. Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. 2. Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt. 3. Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. hekmafarghly73@gmail.com.
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.
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.
Authors: Arnulf Boysen; Martin Ag Lewin; Wolfgang Hecker; Heinz E Leichter; Frank Uhlemann Journal: Pediatr Diabetes Date: 2007-10 Impact factor: 4.866
Authors: Robert D Hoeldtke; Kimberly D Bryner; Daniel R McNeill; Gerald R Hobbs; Jack E Riggs; Sarah S Warehime; Ian Christie; Gary Ganser; Knox Van Dyke Journal: Diabetes Date: 2002-09 Impact factor: 9.461
Authors: Pedro A Latorre-Román; Jesús Salas-Sánchez; Pedro Delgado Floody; Melchor Martínez-Redondo; Pedro J Consuegra-González; Jerónimo Aragón-Vela; Alejandro Robles-Fuentes; Elena Sarabia-Cachadiña; Juan A Párraga-Montilla Journal: Pediatr Res Date: 2021-10-30 Impact factor: 3.953
Authors: Sophie I Mavrogeni; Petros P Sfikakis; Theodoros Dimitroulas; Loukia Koutsogeorgopoulou; George Markousis-Mavrogenis; George Poulos; Genovefa Kolovou; George Theodorakis; George D Kitas Journal: Rheumatol Int Date: 2018-07-24 Impact factor: 2.631
Authors: Elena Daskalaki; Anne Parkinson; Nicola Brew-Sam; Md Zakir Hossain; David O'Neal; Christopher J Nolan; Hanna Suominen Journal: J Med Internet Res Date: 2022-04-08 Impact factor: 7.076
Authors: Lakshini Y Herat; Natalie C Ward; Aaron L Magno; Elizabeth P Rakoczy; Marcio G Kiuchi; Markus P Schlaich; Vance B Matthews Journal: World J Gastroenterol Date: 2020-06-21 Impact factor: 5.742
Authors: Hoda Gad; Bara Al-Jarrah; Saras Saraswathi; Ioannis N Petropoulos; Georgios Ponirakis; Adnan Khan; Parul Singh; Souhaila Al Khodor; Mamoun Elawad; Wesam Almasri; Hatim Abdelrahman; Ahmed Elawwa; Amel Khalifa; Ahmed Shamekh; Fawziya Al-Khalaf; Goran Petrovski; Mahmoud Al Zyoud; Maryam Al Maadheed; Mohamed A Hendaus; Khalid Hussain; Anthony K Akobeng; Rayaz A Malik Journal: J Diabetes Investig Date: 2020-07-07 Impact factor: 4.232