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Aims/hypothesis <p>Our aim was to examine the presence of subclinical cardiovascular autonomic neuropathy (CAN) in a cohort of children with well-regulated type 1 diabetes by measuring baroreceptor sensitivity (BRS), QT variability index (QTVI) and heart rate variability (HRV).</p> Methods <p>Forty-five children (aged 6–15.99 years) with a type 1 diabetes duration of ≥5 years, and 37 healthy control children were included at baseline; and 28 and 18 children, respectively, were included at 2 year follow-up. Cardiac BRS, QTVI and HRV were measured and anthropometrical data and blood samples were collected from all study participants. Longitudinal HbA<sub>1c</sub> values from 3 months after type 1 diabetes diagnosis and continuous glucose monitoring data from the children with type 1 diabetes were also collected.</p> Results <p>Time in normoglycaemia (TING) increased significantly from 42% to 48% between baseline and 2 year follow-up (<i>p</i>=0.042). No difference in BRS, QTVI or HRV were found between the study groups at baseline or follow-up. Children with type 1 diabetes with a BMI <i>z</i> score ≥1 showed higher QTVI compared with either lean children with diabetes or healthy control children. QTVI correlated with type 1 diabetes duration, longitudinal HbA<sub>1c</sub> AUC and cystatin C in children with type 1 diabetes at baseline, and with CV at follow-up. (<i>r</i>=−0.447 <i>p</i>=0.004, <i>r</i>=−0.376 <i>p</i>=0.017, <i>r</i>=−323 <i>p</i>=0.048, and <i>r</i>=0.568 <i>p</i>=0.01, respectively). There was also a correlation between the increase in TING between the study visits and BRS at follow-up in children with type 1 diabetes (<i>r</i>=0.524 <i>p</i>=0.031).</p> Conclusions/interpretation <p>In this well-regulated type 1 diabetes cohort we did not find manifest signs of CAN in children with type 1 diabetes. These are promising findings and should motivate further to keep striving for normoglycaemia in paediatric diabetes care. Children with both type 1 diabetes and overweight seem more susceptible to early development of CAN and might benefit from earlier and more intensive preventive targeting.</p> Graphical Abstract <p></p>

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Influence of glycaemic management and BMI on cardiac autonomic markers in children with type 1 diabetes: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月11日

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  • Ebba Bergdahl,
  • Gun Forsander,
  • Linda Milkovic,
  • Frida Sundberg,
  • Frida Dangardt

摘要

Aims/hypothesis

Our aim was to examine the presence of subclinical cardiovascular autonomic neuropathy (CAN) in a cohort of children with well-regulated type 1 diabetes by measuring baroreceptor sensitivity (BRS), QT variability index (QTVI) and heart rate variability (HRV).

Methods

Forty-five children (aged 6–15.99 years) with a type 1 diabetes duration of ≥5 years, and 37 healthy control children were included at baseline; and 28 and 18 children, respectively, were included at 2 year follow-up. Cardiac BRS, QTVI and HRV were measured and anthropometrical data and blood samples were collected from all study participants. Longitudinal HbA1c values from 3 months after type 1 diabetes diagnosis and continuous glucose monitoring data from the children with type 1 diabetes were also collected.

Results

Time in normoglycaemia (TING) increased significantly from 42% to 48% between baseline and 2 year follow-up (p=0.042). No difference in BRS, QTVI or HRV were found between the study groups at baseline or follow-up. Children with type 1 diabetes with a BMI z score ≥1 showed higher QTVI compared with either lean children with diabetes or healthy control children. QTVI correlated with type 1 diabetes duration, longitudinal HbA1c AUC and cystatin C in children with type 1 diabetes at baseline, and with CV at follow-up. (r=−0.447 p=0.004, r=−0.376 p=0.017, r=−323 p=0.048, and r=0.568 p=0.01, respectively). There was also a correlation between the increase in TING between the study visits and BRS at follow-up in children with type 1 diabetes (r=0.524 p=0.031).

Conclusions/interpretation

In this well-regulated type 1 diabetes cohort we did not find manifest signs of CAN in children with type 1 diabetes. These are promising findings and should motivate further to keep striving for normoglycaemia in paediatric diabetes care. Children with both type 1 diabetes and overweight seem more susceptible to early development of CAN and might benefit from earlier and more intensive preventive targeting.

Graphical Abstract