The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
Diabetes Care. 2022 Oct 1;45(10):2391-2395. doi: 10.2337/dc22-0349.
Cardiac autonomic neuropathy (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of diabetic retinopathy and early kidney dysfunction.
In this prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and albuminuria at baseline, early CAN was defined as one or more abnormalities in seven heart rate tests derived from a 10-min electrocardiogram. Retinopathy was defined as the presence of one or more microaneurysms, early kidney dysfunction as an albumin excretion rate (AER) >7.5 μg/min, and albuminuria as an AER >20 μg/min. Multivariable generalized estimating equations were used to examine the association between CAN and retinopathy or early kidney dysfunction. Cox proportional hazards regression analysis was used to assess cumulative risks of incident retinopathy and albuminuria.
At baseline, the mean age of the sample was 13.6 ± 2.6 years, 52% were male, and mean diabetes duration was 6.1 ± 3.3 years. Over a median follow-up of 3.8 (interquartile range 2.2-7.5) years, the complication rate 27% for retinopathy, 16% for early kidney dysfunction, and 3% for albuminuria. The mean study HbA1c was 72.3 ± 16 mmol/mmol (8.6 ± 1.4%). CAN predicted incident retinopathy (odds ratio 2.0 [95% CI 1.4, 2.9]) and early kidney dysfunction (1.4 [1.0, 2.0]) after adjusting for HbA1c and diabetes duration. CAN also predicted retinopathy (hazard ratio 1.57 [95% CI 1.09, 2.26]) and albuminuria (2.30 [1.05, 5.04]) independently of HbA1c.
CAN predicted incident retinopathy and kidney dysfunction in adolescents with type 1 diabetes, likely reflecting autonomic microvascular dysregulation contributing to complications. Therefore, screening and interventions to reduce CAN may influence the risk of complications.
心脏自主神经病变（CAN）可能导致糖尿病患者发生血管并发症。我们假设，患有 CAN 的青少年患糖尿病视网膜病变和早期肾功能障碍的风险更高。
在这项对 725 名基线时无视网膜病变和白蛋白尿的 1 型糖尿病青少年的前瞻性纵向研究中，早期 CAN 定义为 10 分钟心电图中的 7 项心率测试中存在一项或多项异常。视网膜病变定义为存在一个或多个微动脉瘤，早期肾功能障碍定义为白蛋白排泄率（AER）>7.5μg/min，白蛋白尿定义为 AER>20μg/min。使用多变量广义估计方程来检查 CAN 与视网膜病变或早期肾功能障碍之间的关联。使用 Cox 比例风险回归分析评估视网膜病变和白蛋白尿的累积风险。
在基线时，样本的平均年龄为 13.6±2.6 岁，52%为男性，平均糖尿病病程为 6.1±3.3 年。在中位数为 3.8（四分位距 2.2-7.5）年的随访期间，视网膜病变的发生率为 27%，早期肾功能障碍的发生率为 16%，白蛋白尿的发生率为 3%。平均研究 HbA1c 为 72.3±16mmol/mmol（8.6±1.4%）。在调整了 HbA1c 和糖尿病病程后，CAN 预测了新发视网膜病变（比值比 2.0[95%CI 1.4,2.9]）和早期肾功能障碍（1.4[1.0,2.0]）。CAN 还独立于 HbA1c 预测了视网膜病变（危险比 1.57[95%CI 1.09,2.26]）和白蛋白尿（2.30[1.05,5.04]）。
CAN 预测了 1 型糖尿病青少年新发视网膜病变和肾功能障碍，可能反映了自主神经微血管失调导致的并发症。因此，筛查和干预以降低 CAN 可能会影响并发症的风险。
