Cardiac autonomic nerve dysfunction predicts incident retinopathy and early kidney dysfunction in adolescents with type 1 diabetes

Abstract

<p> </p> <p><strong>Objective:</strong> </p> <p>Cardiac autonomic nerve dysfunction (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of DR and early kidney dysfunction.</p> <p><strong>Research Design and Methods:</strong></p> <p>This is a prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and albuminuria at baseline. Early CAN was defined as <u>></u>1 abnormality of 7 heart rate tests derived from a 10-minute ECG recording using Labchart Pro; retinopathy as the presence of <u>></u>1 microaneurysm, early kidney dysfunction as albumin excretion rate (AER) >7.5 mcg/min and albuminuria as AER >20 mcg/min. Multivariable generalized estimating equations (GEE) were utilized to examine the association between CAN and retinopathy or early kidney dysfunction (Odds ratio with 95% confidence intervals (CI)).Cox- regression analysis assessed cumulative risks of incident retinopathy and albuminuria (hazard ratio with 95% CI). </p> <p><strong>Results:</strong></p> <p>At baseline mean age was 13.6±2.6 years, 52% male, mean diabetes duration 6.1±3.3 years. Over a median follow-up of 3.8 [interquartile range 2.2-7.5] years, complications rates were retinopathy at 27%, early kidney dysfunction at 16%, albuminuria at 3%, mean study HbA1c was 72.3 ± 16 mmol/mmol (8.6 ±1.4%). Cardiac autonomic nerve dysfunction predicted incident retinopathy: OR 2.0 (CI: 1.4, 2.9) and early kidney dysfunction 1.4 (1.0, 2.0) after adjusting for HbA1C and duration. Cardiac autonomic nerve dysfunction predicted retinopathy: HR 1.57 (CI 1.09, 2.26) and albuminuria 2.30 (CI; 1.05, 5.04) independently of HbA1c.</p> <p><strong>Conclusions: </strong></p> <p>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 complications risk. </p>