Early progression of the autonomic dysfunction observed in pediatric type 1 diabetes mellitus.
Lucini, Daniela ; Zuccotti, Gianvincenzo ; Malacarne, Mara ; et al. ; - ASI Sponsor
Nov - 2009
ISSN : 1524-4563 ;
journal : Hypertension

Issue : 5
type: Article Journal

To focus on early cardiac and vascular autonomic dysfunction that might complicate type 1 diabetes mellitus in children, we planned an observational, cross-sectional study in a population of 93 young patients, under insulin treatment, subdivided in 2 age subgroups (children: 11.5+/-0.4 years; adolescents: 19.3+/-0.2 years). Time and frequency domain analysis of RR interval and systolic arterial pressure variability provided quantitative indices of the sympatho-vagal balance regulating the heart period, of the gain of cardiac baroreflex, and of the sympathetic vasomotor control. Sixty-eight children of comparable age served as a reference group. At rest, systolic arterial pressure and the power of its low-frequency component were greater in patients than in controls, particularly in children (14.0+/-2.3 versus 3.1+/-0.3 mm Hg2). Moreover, baroreflex gain was significantly reduced in both subgroups of patients. Standing induced similar changes in the autonomic profiles of controls and patients. A repeat study after 1 year showed a progression in low-frequency oscillations of arterial pressure and a shift toward low frequency in RR variability. Data in young patients with type 1 diabetes mellitus show a significant increase in arterial pressure, a reduced gain of the baroreflex regulation of the heart period, and an increase of the low-frequency component of systolic arterial pressure variability, suggestive of simultaneous impairment of vagal cardiac control and increases of sympathetic vasomotor regulation. A repeat study after 1 year shows a further increase of sympathetic cardiac and vascular modulation, suggesting early progression of the autonomic dysfunction.

keywords : Adolescent,Age Distribution,Analysis of Variance,Autonomic Nervous System Diseases,Autonomic Nervous System Diseases: diagnosis,Autonomic Nervous System Diseases: epidemiology,Autonomic Nervous System Diseases: etiology,Baroreflex,Baroreflex: physiology,Blood Glucose,Blood Glucose: analysis,Child,Cross-Sectional Studies,Diabetes Complications,Diabetes Complications: diagnosis,Diabetes Complications: epidemiology,Diabetes Mellitus,Diabetic Angiopathies,Diabetic Angiopathies: epidemiology,Diabetic Angiopathies: etiology,Diabetic Angiopathies: physiopathology,Diabetic Neuropathies,Diabetic Neuropathies: epidemiology,Diabetic Neuropathies: etiology,Diabetic Neuropathies: physiopathology,Disease Progression,Female,Glycosylated,Glycosylated: analysis,Hemoglobin A,Humans,Insulin,Insulin: therapeutic use,Male,Nonparametric,Probability,Prognosis,Reference Values,Risk Assessment,Severity of Illness Index,Sex Distribution,Statistics,Time Factors,Type 1,Type 1: complications,Type 1: diagnosis,Type 1: drug therapy