Autonomic function in a cohort of children with diabetes

129 diabetic children in Avon County participated in a longitudinal study of the evolution of microvascular disease together with 129 age- and sex-matched controls. Diabetic children had mean (+/- SD) age 12.7 (+/- 3.4) years (range: 3.7-16.8), mean (+/- SD) diabetes duration 3.9 (+/- 3.2) years (range: 0.1-13.4) and mean (+/- SD) HbA1 11.1% (+/- 2.2) (range: 6.5-18.2). Cardiovascular autonomic function was studied by four heart rate (HR) tests using a computerized system of HR monitoring. As a group, diabetic children had higher mean HR (p = 0.0004) and reduced max/min HR ratio while standing (p = 0.001), compared with the control children. HR ratio while standing was the only variable related to diabetes duration (r = -0.20, p = 0.018), while no correlation of HR variables with glycaemic control was found. Twenty diabetic children (15.5%) had one abnormal HR test. Ten diabetic children (7.7%) demonstrated abnormality in two or more HR tests. When compared with the other diabetic children in the cohort, these ten children were found to be younger in age (mean age: 9.4 vs 12.0 yr, p = 0.05), but did not otherwise differ in terms of diabetes duration or glycaemic control. No pubertal or sex effect in the development of diabetic autonomic neuropathy was detected. These findings suggest that autonomic function may be impaired early in childhood diabetes, independent of the duration of the disease or the quality of glycaemic control.