The University of Sydney Children's Hospital Westmead Clinical School, Sydney, New South Wales, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Pediatr Diabetes. 2022 Nov;23(7):1073-1079. doi: 10.1111/pedi.13393. Epub 2022 Aug 9.
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.
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 HbA .
At most recent assessment, youth with type 2 versus type 1 diabetes had median: HbA 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.
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.
心血管自主神经病变（CAN）是一种被忽视但常见且严重的糖尿病并发症。我们研究了青年糖尿病患者的 CAN 及其与心血管危险因素的关系。
这是一项前瞻性队列研究，纳入了年龄<20 岁的 2 型或 1 型糖尿病患者（n=66/1153，中位年龄 15.4/16.5 岁，病程 1.7/8.0 年），研究时间为 2009 年至 2020 年。CAN 的定义为≥2 项异常心率变异性测量值，包括时间、几何和频率域。肥胖定义为 BMI≥第 95 百分位数，重度肥胖定义为≥第 95 百分位数的 120%。使用多变量广义估计方程（GEE）来研究可能与 CAN 相关的危险因素，包括糖尿病类型、肥胖和 HbA1c。
在最近的评估中，与 1 型糖尿病相比，2 型糖尿病患者的中位值为：HbA1c 7.1%（54mmol/mol）与 8.7%（72mmol/mol）和 BMI SDS（2.0 与 0.7）；CAN 发生率（47%与 27%）、周围神经病变（47%与 25%）、高血压（29%与 12%）、白蛋白尿（21%与 3%）和重度肥胖（35%与 2%）。在多变量 GEE 中，CAN 与 2 型糖尿病相关：比值比为 2.53，95%可信区间为 1.46 至 4.38，p=0.001，BMI SDS 越高：1.49，95%可信区间为 1.29 至 1.73，p<0.0001，肥胖：2.09，95%可信区间为 1.57 至 2.78，p<0.0001。
尽管病程较短且年龄较小，但 2 型糖尿病患者的 CAN、周围神经病变、高血压、白蛋白尿和重度肥胖发生率更高。我们的研究结果强调了针对可改变的危险因素以预防糖尿病青少年心血管疾病的重要性。
