Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycaemic control, insulin resistance and hyperandrogenism

Cho, Yoon Hi; Craig, Maria E.; Srinivasan, Shubha; Benitez‐Aguirre, Paul; Mitchell, Paul; Jopling, Tracey; Donaghue, Kim C.

doi:10.1111/cen.12238

Cited by 23 publications

(22 citation statements)

References 38 publications

(59 reference statements)

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“…Obesity has been associated with reduced parasympathetic activity and a relative increase in sympathetic activity in adolescents with and without diabetes (10,19). In contrast, we found that there was no significant difference in BMI SDS in the ACR groups to explain heart rate variance differences between upper and lower ACR tertiles.…”

Section: Discussioncontrasting

confidence: 79%

“…Power spectral analyses of heart rate variability allow more sensitive detection of cardiac autonomic changes than the conventional Ewing battery of tests based on dynamic cardiovascular maneuvers (5,7,8). Recent studies using these modern methods have demonstrated that adverse changes in heart rate variability may be detected during adolescence in people with type 1 diabetes and are primarily associated with poor glycemic control (1,9,10). However, there is a paucity of data on whether cardiac autonomic function is associated with early renal dysfunction before the onset of microalbuminuria.…”

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confidence: 99%

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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)

et al. 2015

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OBJECTIVEThis study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODSAdolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA 1c 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. RESULTSThe 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). HbA 1c 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 (b = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (b = 29.5, 95% CI 218.2 to 20.8, P = 0.03), independent of age and HbA 1c . CONCLUSIONSAdolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lowerrisk 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.

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Section: Discussioncontrasting

confidence: 79%

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confidence: 99%

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)

et al. 2015

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“…Girls seem to be more at risk of overweight, a recognized risk factor for later development of eating disorders . In association with increased weight, there is also the risk of ovarian hyperandrogenism, hirsutism, and polycystic ovarian syndrome . In a recent study of adolescents with hyperandrogenism and type 1 diabetes, metformin treatment significantly decreased serum androgens compared to placebo.…”

Section: Growth Weight Gain and Pubertal Developmentmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

et al. 2018

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“…Six addressed fertility issues and eighteen addressed menstrual cycle characteristics of type 1 diabetes but were unrelated to androgen excess ( Fig. 1 and Supplementary Data), leaving seventeen original articles dealing with androgen excess (8)(9)(10)(11)(12)(13)(14)(15)(16)(24)(25)(26)(27)(28)(29)(30)(31). Only 9 of these 17 articles contained data about the prevalence of PCOS and related traits (8,(10)(11)(12)(13)(14)(15)(16)28) and were included in the meta-analyses.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis

Escobar-Morreale

Roldán-Martín

2016

Diabetes Care

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A few small studies have reported increased prevalences of polycystic ovary syndrome (PCOS) and symptoms of androgen excess in women with type 1 diabetes. PURPOSEWe performed a systematic review and meta-analysis of studies evaluating androgen excess symptoms and PCOS in women with type 1 diabetes. DATA SOURCESThe Entrez-PubMed and Scopus electronic databases were used. STUDY SELECTIONWe selected studies addressing androgen excess signs, symptoms, and disorders in girls, adolescents, and adult women with type 1 diabetes. DATA EXTRACTIONThe main outcome measures were prevalences of PCOS, hyperandrogenemia, hirsutism, menstrual dysfunction, and polycystic ovarian morphology (PCOM). DATA SYNTHESISNine primary studies involving 475 adolescent or adult women with type 1 diabetes were included. The prevalences of PCOS and associated traits in women with type 1 diabetes were 24% (95% CI 15-34) for PCOS, 25% (95% CI 17-33) for hyperandrogenemia, 25% (95% CI 16-36) for hirsutism, 24% (95% CI 17-32) for menstrual dysfunction, and 33% (95% CI 24-44) for PCOM. These figures are considerably higher than those reported earlier in the general population without diabetes. LIMITATIONSThe data collected in the original studies were heterogeneous in age, race, ethnicity, and criteria used for the diagnosis of PCOS; yet, we used a quality-effects model in the meta-analyses to overcome this limitation. CONCLUSIONSPCOS and its related traits are frequent findings in women with type 1 diabetes. PCOS may contribute to the subfertility of these women by a mechanism that does not directly depend on glycemic/metabolic control among other negative consequences for their health. Hence, screening for PCOS and androgen excess should be included in current guidelines for the management of type 1 diabetes in women.

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Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycaemic control, insulin resistance and hyperandrogenism

Abstract: In adolescent girls with diabetes, reduced HRV parameters are associated with worse glycaemic control, lower SHBG and higher weight SDS. SHBG should be considered in the cardiac risk models for this population.

Cited by 23 publications

References 38 publications

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)

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)

ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis

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