The relationship between Cardiac Autonomic Dysfunction and Glycemic Variability in Pediatric Patients with Type 1 Diabetes Mellitus

Abstract

Objective: Objective: Cardiovascular autonomic neuropathy (CAN) is defined as the impairment of cardiovascular autonomic control in patients with diabetes mellitus (DM) after excluding other causes. This study aims to investigate the relationship between glycemic variability and CAN in pediatric patients with type 1 DM Material and Methods: The study population consisted of children aged 8-18 who were being followed up with the diagnosis of type 1 DM. The diagnosis of CAN was made based on the heart rate variability indices and the results of the cardiovascular reflex tests.. Results: The study included 21 pediatric patients with type 1 diabetes mellitus (DM), consisting of 6 males and 15 females, with a median age of 13.94 years. Among them, 5 (23.8%) had early involvement, and 4 (19%) had definitive cardiovascular autonomic neuropathy (CAN). Patients with definitive CAN were significantly older and had a longer disease duration than those without CAN (p<0.05). Additionally, patients with definitive CAN had significantly higher hemoglobin A1c (HbA1c) levels (p<0.05). The time in the target blood glucose range (TIR) was significantly lower, while the time above the target blood glucose range (TAR) was significantly higher in patients with definitive CAN than in other patients (p<0.05). The standard deviation (SD) was also higher in patients with definitive CAN, but not significantly so (p>0.05). Conclusion: The study's findings indicated that TIR, which is one of the glycemic variability parameters, was significantly lower and TAR was considerably higher in children with definitive CAN, and SD was higher, albeit not significantly, in children with definitive CAN. Nevertheless, large-scale, prospective cohort studies are needed to fully elucidate the relationship between CAN and glycemic variability in pediatric type 1 DM patients.