Autonomic nerve function in adolescents with Type 1 diabetes mellitus: relationship to microalbuminuria.
OBJECTIVE
Thirty adolescent patients with Type 1 diabetes mellitus and microalbuminuria were studied for evidence of early autonomic neuropathy.


METHODS
Using tests involving cardiovascular and pupillary reflexes, the adolescents were compared with a normoalbuminuric group of patients with diabetes, who were matched for age, sex, puberty and duration of diabetes.


RESULTS
There was an increased prevalence of autonomic nerve dysfunction in the patients with microalbuminuria. These patients had higher resting heart rates (86 beats/min in the microalbuminuric group vs. 77 beats/min in normoalbuminuric controls, P = 0.002), and impaired pupillary dilatation in darkness (pupillary diameter % 56.5% vs. 62.5%, P = 0.003). Patients with microalbuminuria also had poorer long term glycaemic control (mean HbA1C 8.7% vs. 7.8%, P = 0.002) and higher blood pressures (systolic 125 vs. 116 mmHg, P = 0.001; diastolic 69 vs. 62 mmHg, P = 0.0001; mean arterial pressure 90 vs. 83 mmHg, P = 0.002) than those with normal urinary albumin excretion.


CONCLUSIONS
Microalbuminuria and autonomic nerve dysfunction co-exist in patients with Type 1 DM. Longitudinal studies will determine whether these findings have implications for the identification of patients at higher risk of progression of early renal complications.
Clarke
C F
CF
Department of Endocrinology & Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.
Eason
M
M
Reilly
A
A
Boyce
D
D
Werther
G A
GA
D000293:Adolescent; D000419:Albuminuria; D001315:Australia / Q000453:epidemiology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology* / Q000652:urine; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D011187:Posture; D015995:Prevalence; D012025:Reflex, Pupillary; D014280:Triglycerides / Q000097:blood
D002784:Cholesterol; D006442:Glycated Hemoglobin; D014280:Triglycerides