Risk for cardiovascular autonomic neuropathy is associated with the HLA-DR3/4 phenotype in type I diabetes mellitus.
OBJECTIVE
To identify risk factors for the development of cardiovascular autonomic neuropathy in patients with juvenile-onset type I diabetes mellitus.


METHODS
Cross-sectional examination of an inception cohort 15 to 21 years after the onset of diabetes.


METHODS
Outpatient diabetes clinic.


METHODS
Seventy-nine patients with type I diabetes who experienced onset of disease before 21 years of age and who were followed for 15 to 21 years.


METHODS
Autonomic nerve function was evaluated in all patients using deep breathing and tilt tests. On the basis of these tests, an index of cardiovascular autonomic neuropathy was derived and patients were classified as having intact, mildly impaired, or significantly impaired autonomic function.


RESULTS
The group with significantly impaired function had a higher mean hemoglobin A1 at the time of examination than the group without impairment, yet the groups did not differ regarding glycemic control during the first decade of diabetes. The HLA-DR3/4 phenotype was present in more than 50% of the patients with significant autonomic dysfunction and conferred relative odds of 6.2 (95% CI, 1.7 to 23.3) for the development of autonomic neuropathy when compared with other HLA-DR phenotypes. Sex, percent ideal body weight, and smoking did not have a statistically significant effect on the development of autonomic neuropathy.


CONCLUSIONS
The development of cardiovascular autonomic neuropathy in type I diabetes mellitus is strongly associated with the HLA-DR3/4 phenotype. Thus, genetic predisposition may play an important role in the development of this complication.
Barzilay
J
J
Joslin Diabetes Center, Boston, Massachusetts.
Warram
J H
JH
Rand
L I
LI
Pfeifer
M A
MA
Krolewski
A S
AS
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D015803:HLA-DR3 Antigen / Q000097:blood* / Q000235:genetics; D015804:HLA-DR4 Antigen / Q000097:blood* / Q000235:genetics; D006439:Hemodynamics / Q000276:immunology / Q000502:physiology; D006801:Humans; D008297:Male; D010641:Phenotype; D012044:Regression Analysis; D012119:Respiration / Q000502:physiology; D012307:Risk Factors
D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen