title: Association of autoimmunity to autonomic nervous structures with nerve function in patients with type 1 diabetes: a 16-year prospective study.
abstract: OBJECTIVE We prospectively evaluated the association between autoimmunity to autonomic nervous structures and autonomic neuropathy in type 1 diabetes in relation to clinical variables. RESEARCH DESIGN AND METHODS A cohort of 112 patients with type 1 diabetes was prospectively followed from adolescence (T0) to approximately 4 (T4) and 16 (T16) years later. Standard cardiovascular (CV) tests and neurological examination were performed and related to the presence of circulating antibodies (Ab) to autonomic nervous structures detected at T0 and T4. Quality of life was assessed by a diabetes-specific questionnaire. RESULTS Sixty-six patients (59% of the cohort) were reexamined at T16 (age 31.4 ± 2 years; disease duration 23.4 ± 3.7 years). Nineteen had circulating Ab to autonomic structures. Prevalence of abnormal tests and autonomic symptoms were higher in Ab-positive (68 and 26%, respectively) than Ab-negative (32 and 4%) patients (P < 0.05). Among Ab-positive patients, the relative risk (RR) of having at least one altered CV test was 5.77 (95% CI 1.56-21.33), and an altered deep breathing (DB) test (<15 bpm) was 14.65 (2.48-86.46). Previous glycemic control was the only other predictor (RR 1.06 [1.002-1.13]/mmol/mol HbA1c increase). Presence of Ab carried over a 68% probability of developing an altered CV test; absence of Ab carried a 91% probability of not having an altered DB test and an 89% probability of not having an altered Valsalva ratio. Autonomic neuropathy was independently associated with worse quality of life. CONCLUSIONS Circulating Ab to autonomic structures are associated with the development of autonomic dysfunction in young diabetic patients independent of glycemic control.
authors.affiliation: Corresponding author: Maria M. Zanone, mmz@libero.it.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Zanone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Raviolo
authors.forename: Eleonora
authors.initials: E
authors.lastname: Coppo
authors.forename: Marina
authors.initials: M
authors.lastname: Trento
authors.forename: Martina
authors.initials: M
authors.lastname: Trevisan
authors.forename: Franco
authors.initials: F
authors.lastname: Cavallo
authors.forename: Enrica
authors.initials: E
authors.lastname: Favaro
authors.forename: Pietro
authors.initials: P
authors.lastname: Passera
authors.forename: Massimo
authors.initials: M
authors.lastname: Porta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Camussi
mesh_terms: D000328:Adult; D015551:Autoimmunity; D001341:Autonomic Nervous System / Q000276:immunology*; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000276:immunology*; D003929:Diabetic Neuropathies / Q000276:immunology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D001786:Blood Glucose