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)

Cho, Yoon Hi, Craig, Maria E., Davis, Elizabeth A., Cotterill, Andrew M., Couper, Jennifer J., Cameron, Fergus J., Benitez-Aguirre, Paul Z., Dalton, R. Neil, Dunger, David B., Jones, Timothy W. and Donaghue, Kim C. (2015) 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). Diabetes Care, 38 4: 676-681. doi:10.2337/dc14-1848

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Author Cho, Yoon Hi
Craig, Maria E.
Davis, Elizabeth A.
Cotterill, Andrew M.
Couper, Jennifer J.
Cameron, Fergus J.
Benitez-Aguirre, Paul Z.
Dalton, R. Neil
Dunger, David B.
Jones, Timothy W.
Donaghue, Kim C.
Title 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)
Journal name Diabetes Care   Check publisher's open access policy
ISSN 0149-5992
1935-5548
Publication date 2015-04
Sub-type Article (original research)
DOI 10.2337/dc14-1848
Open Access Status Not Open Access
Volume 38
Issue 4
Start page 676
End page 681
Total pages 6
Place of publication Alexandria, United States
Publisher American Diabetes Association
Collection year 2016
Language eng
Formatted abstract
Objective: This study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes.

Research design and methods: Adolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10–17 years, mean duration 6.9 years; mean HbA1c 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.

Results: The 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). HbA1c 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 (β = 2.5, 95% CI 0.2–4.8, P = 0.03) and lower RMSSD (β = −9.5, 95% CI −18.2 to −0.8, P = 0.03), independent of age and HbA1c.

Conclusions: Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lower-risk 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.
Keyword Heart rate variability
Nephropathy
Neuropathy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
 
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