Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Pediatr Diabetes. 2018 Aug;19(5):1020-1024. doi: 10.1111/pedi.12680. Epub 2018 May 7.
Type 1 diabetes (T1D) is a chronic source of metabolic and neuropsychological stress, which may eventually lead to autonomic neuropathy and other complications related to micro- and macro-vasculopathies. We aimed to investigate the relationship between T1D chronic stress and autonomic response to acute stress testing that was expected being affected by chronic stress.
Twenty youths with confirmed diagnosis of T1D were assessed. Chronic stress assessment included hemoglobin A1c (HbA1c) ≥7.5%, psychological stress assessed by perceived stress scale (PSS), hypoglycemic events, and proinflammatory cytokines. The acute stress testing used standardized stress video games. Autonomic response to acute stress was assessed by the amplitude and direction of changes in heart rate variability. Analyses determined correlations between changes in parasympathetic nervous system during stress testing and chronic diabetes stressors.
A strong correlation was found between the amplitude of high frequency (HF) changes and HbA1c values (ρ = 0.74, P < .001). Youths with HbA1c ≥7.5% showed a larger amplitude of HF changes during acute stress (49% vs 16%, P < .001) and a higher PSS score (22.5 vs 19.0, P = .003), compared to those with HbA1c <7.5%. Additionally, among youths with HbA1c ≥7.5%, those with positive changes in HF had a lower level of IL-8 than those with negative changes (5.40 vs 7.85 pg/mL, P = .009).
Study findings support the need for better understanding the health effects of stress-related autonomic dysfunction in youth with T1D.
1 型糖尿病（T1D）是一种慢性代谢和神经心理应激源，最终可能导致自主神经病变和其他与微血管和大血管病变相关的并发症。我们旨在研究 T1D 慢性应激与自主神经对急性应激测试的反应之间的关系，预计这种反应会受到慢性应激的影响。
评估了 20 名确诊为 T1D 的年轻人。慢性应激评估包括糖化血红蛋白（HbA1c）≥7.5%、感知应激量表（PSS）评估的心理应激、低血糖事件和促炎细胞因子。急性应激测试采用标准化应激视频游戏。自主神经对急性应激的反应通过心率变异性变化的幅度和方向来评估。分析确定了应激测试期间副交感神经系统变化与慢性糖尿病应激源之间的相关性。
发现高频（HF）变化幅度与 HbA1c 值之间存在很强的相关性（ρ=0.74，P<0.001）。HbA1c≥7.5%的年轻人在急性应激时 HF 变化幅度更大（49%比 16%，P<0.001），PSS 评分更高（22.5 比 19.0，P=0.003），与 HbA1c<7.5%的年轻人相比。此外，在 HbA1c≥7.5%的年轻人中，HF 有阳性变化的人其白细胞介素-8 水平低于 HF 有阴性变化的人（5.40 比 7.85 pg/mL，P=0.009）。
研究结果支持需要更好地了解 T1D 青少年应激相关自主神经功能障碍的健康影响。
