Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes. Issue 4 (31st January 2018)

• Record Type: Journal Article
• Authors: Cho, Yoon H; Craig, Maria E; Jopling, Tracey; Chan, Albert; Donaghue, Kim C
• Is Part Of: Pediatric diabetes. Volume 19:Issue 4(2018)
• Page Start: 794
• Page End: 800
• Publication Date: 2018-01-31
• Subjects: adolescents -- body mass index -- cardiac autonomic neuropathy -- obesity -- type 1 diabetes; Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.12642
• Languages: English
• ISSNs: 1399-543X

Abstract

Abstract : Background: Obesity is associated with an increased risk of cardiovascular morbidity in adults with diabetes. Objective: To examine the predictive role of body mass index (BMI) and adiposity on cardiac autonomic function in childhood onset type 1 diabetes. Subjects: Two hundred and fifty‐three participants with type 1 diabetes (aged 8‐30 years) were assessed for diabetes complications at a tertiary hospital, and followed over 7 years (total 922 visits). Methods: Heart rate variability (HRV) measures assessed by 10‐minute electrocardiography recording using LabChart Pro were standard deviation of RR intervals, time between consecutive QRS complexes, [SDNN], root mean squared difference of successive RR intervals (RMSSD), triangular index (TI), and low to high frequency ratio [LF:HF]. Multivariable generalized estimating equations were used to model the longitudinal associations between HRV measures and clinical variables (BMI standard deviation scores [SDS], waist:height ratio, total daily insulin dose/kg (TDD) and hemoglobin A1c [HbA1c]). Results: At baseline, mean age was 14.4 ± 2.7 years, diabetes duration 7.1 ± 3.7 years, HbA1c 8.3% ± 1.5% (67 ± 16 mmol/mol), and 33% were overweight/obese (BMI ≥85th percentile). At final visit, mean age was 18.5 ± 2.7 years, duration 11.3 ± 3.9 years, HbA1c 9.0% ± 1.8% (75 ± 20 mmol/mol), and 40% were overweight/obese. Adiposity (higher BMI SDS or waist: height ratio) was a significant predictor of worse HRV (lower SDNN, RMSSD; P < .05), while higher HbA1c and TDD predicted all adverse HRV measures (lower SDNN, RMSSD, TI; P < .05) and abnormal sympathovagal balance (higher LF:HF ratio; P < .05). Conclusions: Higher BMI and central adiposity are associated with cardiac autonomic dysfunction in childhood onset type 1 diabetes, after adjusting for HbA1c. Interventions targeting overweight/obesity during adolescence may optimize long‐term vascular health in type 1 diabetes.