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. 2022 Nov;23(7):1073-1079.
doi: 10.1111/pedi.13393. Epub 2022 Aug 9.

Higher frequency of cardiovascular autonomic neuropathy in youth with type 2 compared to type 1 diabetes: Role of cardiometabolic risk factors

Benjamin J Varley  1 , Megan L Gow  1   2 , Yoon Hi Cho  1   3 , Paul Benitez-Aguirre  3 , Janine Cusumano  3 , Alison Pryke  3 , Albert Chan  3 , Vallimayil Velayutham  1   3   4 , Kim C Donaghue  1   3 , Maria E Craig  1   2   3
Affiliations

Higher frequency of cardiovascular autonomic neuropathy in youth with type 2 compared to type 1 diabetes: Role of cardiometabolic risk factors

Benjamin J Varley et al. Pediatr Diabetes. 2022 Nov.

Abstract

Objective: Cardiovascular autonomic neuropathy (CAN) is an overlooked but common and serious diabetes complication. We examined CAN in youth with diabetes and associations with cardiovascular risk factors.

Research design and methods: This was a prospective cohort of youth aged <20 years with type 2 or type 1 diabetes (n = 66/1153, median age 15.4/16.5 years, duration 1.7/8.0 years), assessed between 2009 and 2020. CAN was defined as ≥2 abnormal heart rate variability measures across time, geometric, and frequency domains. Obesity was defined as BMI ≥ 95th percentile and severe obesity as ≥120% of 95th percentile. Multivariable generalized estimating equations (GEE) were used to examine putative risk factors for CAN, including diabetes type, obesity, and HbA1c .

Results: At most recent assessment, youth with type 2 versus type 1 diabetes had median: HbA1 c 7.1% (54 mmol/mol) versus 8.7% (72 mmol/mol) and BMI SDS (2.0 vs. 0.7); frequency of CAN (47% vs. 27%), peripheral nerve abnormality (47% vs. 25%), hypertension (29% vs. 12%), albuminuria (21% vs. 3%), and severe obesity (35% vs. 2%). In multivariable GEE, CAN was associated with type 2 diabetes: Odds Ratio 2.53, 95% CI 1.46, 4.38, p = 0.001, higher BMI SDS: 1.49, 95% CI 1.29, 1.73, p < 0.0001, and obesity: 2.09, 95% CI 1.57, 2.78, p < 0.0001.

Conclusions: Youth with type 2 diabetes have a higher frequency of CAN, peripheral nerve abnormality, hypertension, albuminuria and severe obesity despite shorter diabetes duration and younger age. Our findings highlight the importance of targeting modifiable risk factors to prevent cardiovascular disease in youth with diabetes.

Keywords: cardiovascular autonomic neuropathy; cardiovascular disease; heart rate variability; obesity; youth.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Frequency of diabetes complications by BMI category for youth with type 1 diabetes at most recent visit. p values calculated with Chi square. T1D: under/normal n = 750, overweight n = 272, obesity n = 105, severe obesity n = 26. AER, albumin excretion rate; CAN, cardiovascular autonomic neuropathy
See this image and copyright information in PMC

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