Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1995 Dec;73(6):515–518. doi: 10.1136/adc.73.6.515

Cardiovascular autonomic dysfunction in diabetes mellitus.

L Barkai 1, L Madácsy 1
PMCID: PMC1511446  PMID: 8546508

Abstract

The aim was to assess cardiovascular autonomic dysfunction in children and adolescents with diabetes mellitus. A total of 110 children and adolescents with type 1 (insulin dependent) diabetes (aged 6 to 18 years) and 130 non-diabetic controls were studied. Resting heart rate, heart rate variation to deep breathing, heart rate response to standing from a lying position, fall in systolic blood pressure on standing, and rise in diastolic blood pressure during sustained handgrip were measured. A reference range of results was obtained in the controls. Diabetic children had significantly increased resting heart rate [92.4 (SEM 2.5) v 84.2 (2.2) beats/min], decreased deep breathing heart rate variation [25.3 (0.9) v 32.8 (0.6) beats/min], and lower standing/lying heart rate ratio [1.23 (0.04) v 1.31 (0.03)] compared with controls. 46 diabetic children (42%) had at least one abnormal autonomic test result. Of these, 20 (15%) had only one abnormal test and 26 (24%) had two or more abnormal tests. Using multiple logistic regression analysis, longer diabetes duration and worse long term metabolic control were independently predictive of cardiovascular autonomic dysfunction as the dependent variable [adjusted OR (95% CI): 2.9 (1.1-5.9) and 3.3 (1.2-6.4), respectively]. Cardiovascular autonomic dysfunction is not rare in children with diabetes. Efforts should be made to maintain the best metabolic control to prevent or delay these complications.

Full text

PDF
515

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akinci A., Celiker A., Baykal E., Teziç T. Heart rate variability in diabetic children: sensitivity of the time- and frequency-domain methods. Pediatr Cardiol. 1993 Jul;14(3):140–146. doi: 10.1007/BF00795641. [DOI] [PubMed] [Google Scholar]
  2. Barkai L., Madácsy L., Kassay L. Investigation of subclinical signs of autonomic neuropathy in the early stage of childhood diabetes. Horm Res. 1990;34(2):54–59. doi: 10.1159/000181795. [DOI] [PubMed] [Google Scholar]
  3. Barkai L., Madácsy L., Vámosi I. Autonomic dysfunction and severe hypoglycaemia in insulin dependent diabetes mellitus. Arch Dis Child. 1991 Dec;66(12):1438–1441. doi: 10.1136/adc.66.12.1438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barkai L., Szabó L. Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy. Eur J Pediatr. 1993 Mar;152(3):190–192. doi: 10.1007/BF01956141. [DOI] [PubMed] [Google Scholar]
  5. Bellavere F., Ferri M., Guarini L., Bax G., Piccoli A., Cardone C., Fedele D. Prolonged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death? Br Heart J. 1988 Mar;59(3):379–383. doi: 10.1136/hrt.59.3.379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Clements R. S., Jr, Bell D. S. Diagnostic, pathogenetic, and therapeutic aspects of diabetic neuropathy. Spec Top Endocrinol Metab. 1982;3:1–43. [PubMed] [Google Scholar]
  7. Ewald U., Tuvemo T. Reduced vascular reactivity in diabetic children and its relation to diabetic control. Acta Paediatr Scand. 1985 Jan;74(1):77–84. doi: 10.1111/j.1651-2227.1985.tb10924.x. [DOI] [PubMed] [Google Scholar]
  8. Ewing D. J., Campbell I. W., Clarke B. F. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med. 1980 Feb;92(2 Pt 2):308–311. doi: 10.7326/0003-4819-92-2-308. [DOI] [PubMed] [Google Scholar]
  9. Ewing D. J., Campbell I. W., Clarke B. F. Heart rate changes in diabetes mellitus. Lancet. 1981 Jan 24;1(8213):183–186. doi: 10.1016/s0140-6736(81)90061-1. [DOI] [PubMed] [Google Scholar]
  10. Ewing D. J., Clarke B. F. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982 Oct 2;285(6346):916–918. doi: 10.1136/bmj.285.6346.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fisher B. M., Frier B. M. Usefulness of cardiovascular tests of autonomic function in asymptomatic diabetic patients. Diabetes Res Clin Pract. 1989 Feb 15;6(2):157–160. doi: 10.1016/0168-8227(89)90121-6. [DOI] [PubMed] [Google Scholar]
  12. Hilsted J., Jensen S. B. A simple test for autonomic neuropathy in juvenile diabetics. Acta Med Scand. 1979;205(5):385–387. doi: 10.1111/j.0954-6820.1979.tb06069.x. [DOI] [PubMed] [Google Scholar]
  13. Kahn J. K., Sisson J. C., Vinik A. I. QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. J Clin Endocrinol Metab. 1987 Apr;64(4):751–754. doi: 10.1210/jcem-64-4-751. [DOI] [PubMed] [Google Scholar]
  14. Madácsy L., Yasar A., Tulassay T., Körner A., Kelemen J., Hóbor M., Miltényi M. Relative nocturnal hypertension in children with insulin-dependent diabetes mellitus. Acta Paediatr. 1994 Apr;83(4):414–417. doi: 10.1111/j.1651-2227.1994.tb18132.x. [DOI] [PubMed] [Google Scholar]
  15. Mitchell E. A., Wealthall S. R., Elliott R. B. Diabetic autonomic neuropathy in children: immediate heart-rate response to standing. Aust Paediatr J. 1983 Sep;19(3):175–177. doi: 10.1111/j.1440-1754.1983.tb02087.x. [DOI] [PubMed] [Google Scholar]
  16. Mitchell E. A., Wealthall S. R., Elliott R. B. Tests for autonomic neuropathy in diabetic children. Aust Paediatr J. 1985 May;21(2):105–109. doi: 10.1111/j.1440-1754.1985.tb00138.x. [DOI] [PubMed] [Google Scholar]
  17. Pfeifer M. A., Cook D., Brodsky J., Tice D., Reenan A., Swedine S., Halter J. B., Porte D., Jr Quantitative evaluation of cardiac parasympathetic activity in normal and diabetic man. Diabetes. 1982 Apr;31(4 Pt 1):339–345. doi: 10.2337/diab.31.4.339. [DOI] [PubMed] [Google Scholar]
  18. Rogers D. G., White N. H., Shalwitz R. A., Palmberg P., Smith M. E., Santiago J. V. The effect of puberty on the development of early diabetic microvascular disease in insulin-dependent diabetes. Diabetes Res Clin Pract. 1987 Jan-Feb;3(1):39–44. doi: 10.1016/s0168-8227(87)80006-2. [DOI] [PubMed] [Google Scholar]
  19. Sosenko J. M., Boulton A. J., Kubrusly D. B., Weintraub J. K., Skyler J. S. The vibratory perception threshold in young diabetic patients: associations with glycemia and puberty. Diabetes Care. 1985 Nov-Dec;8(6):605–607. doi: 10.2337/diacare.8.6.605. [DOI] [PubMed] [Google Scholar]
  20. Young R. J., Ewing D. J., Clarke B. F. Nerve function and metabolic control in teenage diabetics. Diabetes. 1983 Feb;32(2):142–147. doi: 10.2337/diab.32.2.142. [DOI] [PubMed] [Google Scholar]
  21. Young R. J., Macintyre C. C., Martyn C. N., Prescott R. J., Ewing D. J., Smith A. F., Viberti G., Clarke B. F. Progression of subclinical polyneuropathy in young patients with type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications). Diabetologia. 1986 Mar;29(3):156–161. doi: 10.1007/BF02427086. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES