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Autonomic neuropathy in diabetic children
A Verrotti1, F Chiarelli, A Blasetti
1Department of Pediatrics, University of Chieti, Italy.
Journal of Paediatrics and Child Health
|December 1, 1995
Summary
Cardiovascular autonomic nerve dysfunction is common in children with insulin-dependent diabetes mellitus, even when asymptomatic. Specific heart rate tests effectively detect these abnormalities in pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Physiology
- Diabetic Complications
Background:
- Insulin-dependent diabetes mellitus (IDDM) can lead to long-term complications.
- Cardiovascular autonomic nerve dysfunction (CAND) is a known complication of diabetes.
- Early detection of CAND is crucial for managing diabetic complications in children.
Purpose of the Study:
- To evaluate the prevalence of CAND in children and adolescents with IDDM.
- To identify sensitive diagnostic markers for CAND in this pediatric population.
Main Methods:
- A study involving 110 children and adolescents with IDDM and 100 healthy controls.
- Assessment of autonomic nerve function using standard cardiovascular reflex tests.
- Analysis included blood pressure response to standing and handgrip, heart rate response to standing, beat-to-beat heart rate variation during deep breathing, and Valsalva maneuver.
Main Results:
- 47% of diabetic children and adolescents exhibited one or more abnormal cardiovascular autonomic function tests.
- Abnormalities ranged from early (22 patients) to definite (18 patients) and severe (7 patients) involvement.
- No significant correlation was found between CAND and factors like sex, glycaemic control, diabetes duration, or microalbuminuria.
Conclusions:
- CAND is present in asymptomatic pediatric patients with IDDM.
- Heart rate variation during the Valsalva maneuver and the 30:15 ratio are the most sensitive indicators for detecting autonomic dysfunction in children with diabetes.