Формування груп ризику з урахуванням інтервалу QT й QT-коригованого у дітей, хворих на цукровий діабет 1 типу

Abstract

The course of type 1 diabetes in children can be complicated by cardiovascular disorders in the form of life-threatening arrhythmias, especially in patients with congenital long QT syndrome (LQTS). It remains relevant to determine the risk groups for developing such complications, to search for convenient diagnostic algorithms and subsequent management tactics for children with type 1 diabetes mellitus (T1DM) who have acquired and congenital long LQTS. Study purpose is to determine the risk groups for the development of cardiovascular complications of type 1 diabetes mellitus in children, by the QT and corrected (QTc) interval ranges. Materials and methods. The examination involved 53 children with type 1 diabetes, who were divided into 2 groups depending on the duration of the disease. To determine the parameters relevant for the study, the bioelectrical activity of the heart was assessed by ECG and Holter ECG monitoring. For additional assessment of the patients' condition over a long period of time, they were offered to keep a diary with monitoring of parameters important for the study. Statistical processing of the research results was carried out with the SPSS 22.0 program. Results and conclusions. Changes in the duration of the QTc interval and its variance have been proved depending on the duration of the disease and influence of the glycemia level plus insulin therapy on the value of these indicators. For children with newly diagnosed type 1 diabetes, an algorithm has been developed to identify risk groups for the development of cardiovascular complications associated with LQTS, which makes it possible to determine three risk groups and the tactics of their further management. According to the authors, the main goal of reducing the risk of developing cardiovascular complications in the form of ventricular arrhythmias (which can lead to sudden death syndrome) is the timely diagnosis of long QT interval syndrome. Recognition of congenital LQTS is important, since unstable glycemic levels and the appointment of insulin therapy can significantly worsen the child's condition. For children with newly diagnosed type 1 diabetes mellitus before the appointment of insulin therapy, the authors propose their own algorithm for identifying risk groups for the development of cardiovascular complications associated with long QT interval syndrome and tactics for their further management. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: type 1 diabetes, long QT syndrome, patient management algorithm.