Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes

Abstract

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.

Associations between circulating inflammatory markers, diabetes type and complications in youth

“…Heart rate variability (HRV), a measure of cardiac autonomic function, was assessed as previously described, using LabChart Pro (AD Instruments, Sydney, NSW, Australia), based on a 10 minutes continuous EKG (ectopics excluded) in rested supine patients. One operator visually scanned the trace for R‐waves among artifacts and ectopic beats.…”

“…Heart rate variability (HRV), a measure of cardiac autonomic function, was assessed as previously described, 19 using LabChart Pro (AD Instruments, Sydney, NSW, Australia), based on a 10 minutes continuous EKG (ectopics excluded) in rested supine patients. One Elevated heart rate and HRV abnormalities were defined as ≥1 abnormality in those seven categories based on ≤5 or ≥95th percentiles in age-and sex-matched control subjects measured using the same equipment.…”

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

“…The Diabetes Control and Complications Trial and other studies reported increased weight gain as a side effect of intensive insulin therapy with improved glycemic control . Obese children with type 1 diabetes have a higher prevalence of cardiovascular risk factors (hypertension, dyslipidemia, and cardiac autonomic dysfunction) than normal‐weight children with type 1 diabetes . Given that recent data from multiple international registries show higher rates of overweight and obesity in children and adolescents with type 1 diabetes compared with their non‐diabetic peers, careful monitoring and management of weight gain should be emphasized in diabetes care as obesity is a modifiable cardiovascular risk factor .…”

“…12,[20][21][22] Obese children with type 1 diabetes have a higher prevalence of cardiovascular risk factors (hypertension, dyslipidemia, and cardiac autonomic dysfunction) than normal-weight children with type 1 diabetes. 23,24 Given that recent data from multiple international registries show higher rates of overweight and obesity in children and adolescents with type 1 diabetes compared with their non-diabetic peers, careful monitoring and management of weight gain should be emphasized in diabetes care as obesity is a modifiable cardiovascular risk factor. 25,26 Use of adjuvant therapy with insulin sensitizing agents, such as the addition of metformin along with insulin does not improve glycemic control among overweight adolescents with type 1 diabetes; however, it may lead to less insulin requirements and a reduction of BMI.…”

A pilot study of the effects of a high‐intensity aerobic exercise session on heart rate variability and arterial compliance in adolescents with or without type 1 diabetes

“…In larger epidemiological studies with longitudinal follow‐up, adolescents and young adults with T1D were more likely to develop cardiac autonomic dysfunction if they have elevated HbA1c, BMI, and BP . In the SEARCH study, prevalence of autonomic dysfunction was also higher in males than females and increased with age .…”