Early progression of the autonomic dysfunction observed in pediatric type 1 diabetes mellitus.
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.
Lucini
Daniela
D
Centro Ricerca Terapia Neurovegetativa, University of Milan, Milan, Italy.
Zuccotti
Gianvincenzo
G
Malacarne
Mara
M
Scaramuzza
Andrea
A
Riboni
Sara
S
Palombo
Carlo
C
Pagani
Massimo
M
D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D017704:Baroreflex / Q000502:physiology; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin