Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes. Incidence and predictors.
The pathogenesis of diabetic neuropathy is poorly understood. In this prospective study, we investigated the incidence rate and potential predictors for cardiovascular autonomic neuropathy (CAN) in a cohort of childhood-onset type 1 diabetic patients. Subjects from the Epidemiology of Diabetes Complications Study were examined at baseline and then biennially. CAN was diagnosed by abnormal (</=1. 1) expiration/inspiration ratio during deep breathing. During the 4. 7-year mean follow-up period, CAN developed in 104 patients from the 373 subjects who were free of CAN at baseline and provided follow-up data, an incidence-density of 5.9 cases/100 person-years. Cox proportional hazard modeling showed age (relative risk [RR]=2.15, p=0.0001), HbA1 (RR=1.50, p=0.0002) and nephropathy (albumin excretion >200 ug/min) (RR=2.46, p=0.0001) to be significant independent predictors. Hypertension was, however, predictive if nephropathy was not included in the model. We conclude that beyond age and poor glycemic control, nephropathy is a significant risk factor for CAN and this association may explain some of the increased mortality seen in CAN.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, DLR Building, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Stella
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Ellis
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Maser
T J
TJ
Orchard
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006321:Heart / Q000294:innervation*; D006801:Humans; D008297:Male; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D005340:Fibrinogen; D006442:Glycated Hemoglobin; D014280:Triglycerides