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Type: Journal article
Title: 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)
Author: Cho, Y.
Craig, M.
Davis, E.
Cotterill, A.
Couper, J.
Cameron, F.
Benitez-Aguirre, P.
Dalton, R.
Dunger, D.
Jones, T.
Donaghue, K.
Citation: Diabetes Care, 2015; 38(4):676-681
Publisher: American Diabetes Association
Issue Date: 2015
ISSN: 0149-5992
Statement of
Yoon Hi Cho, Maria E. Craig, Elizabeth A. Davis, Andrew M. Cotterill, Jennifer J. Couper, Fergus J. Cameron, Paul Z. Benitez-Aguirre, R. Neil Dalton, David B. Dunger, Timothy W. Jones, and Kim C. Donaghue, on behalf of the Adolescent Type, Diabetes Cardio-Renal Intervention Trial, (AdDIT)
Abstract: 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.
Keywords: Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial
Rights: © 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.
DOI: 10.2337/dc14-1848
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Paediatrics publications

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