Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal interventional trial).

Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE

Publication: Alexandria Va : American Diabetes Association
Original Publication: New York, American Diabetes Assn.

Albumins/*metabolism ; Autonomic Nervous System/*physiopathology ; Creatinine/*blood ; Diabetes Mellitus, Type 1/*complications ; Diabetes Mellitus, Type 1/*physiopathology ; Diabetic Nephropathies/*etiology ; Heart/*physiopathology; Adolescent ; Blood Pressure/physiology ; Diabetes Mellitus, Type 1/blood ; Diabetic Nephropathies/blood ; Diabetic Nephropathies/physiopathology ; Diabetic Nephropathies/prevention & control ; Electrocardiography ; Female ; Heart/innervation ; Heart Rate/physiology ; Humans ; Male ; Risk Factors

Objective: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes.
Research Design and Methods: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk.
Results: The upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis, upper-tertile ACR was associated with faster heart rate (β = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (β = -9.5, 95% CI -18.2 to -0.8, P = 0.03), independent of age and HbA1c.
Conclusions: Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lower-risk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population.
(© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)

06/0003341 United Kingdom DUK_ Diabetes UK

Investigator: P Bergman; C Rodda; B King; C Verge; C Acerini; F Ackland; B Anand; T Barrett; V Birrell; F Campbell; T Cheetham; C Cooper; I Doughty; A Dutta; J Edge; J Hamilton-Shield; J Heywood; N Leech; N Mann; R Parker; G Rayman; JM Robinson; M Russell-Taylor; V Sankar; N Thalange; M Wilson; D Daneman; F Mahmud; C Clarson; J Curtis; E Sochett

0 (Albumins)
AYI8EX34EU (Creatinine)

Date Created: 20150110 Date Completed: 20151001 Latest Revision: 20220311

20240104

10.2337/dc14-1848

25573882