Evidence of defective cardiovascular regulation in insulin-dependent diabetic patients without clinical autonomic dysfunction

Weston, Philip J.; James, Martin; Panerai, R.B.; McNally, Paul; Potter, John F.; Thurston, H.

doi:10.1016/s0168-8227(98)00094-1

Cited by 57 publications

(47 citation statements)

References 29 publications

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“…Essentially, these previous findings were replicated here by: (1) showing a lower global HRV (assessed by the SD of RR interval); (2) the relative increase in the lowfrequency components; (3) the relative and absolute reduction in the high-frequency components of HRV; and (4) the higher low-frequency:high-frequency ratio, as assessed by spectral analysis. It is of note that reduced BRS was found to be a sensitive marker of autonomic cardiovascular dysregulation in a population of type 1 diabetic patients with a wide range of age and diabetes duration [10] and that such a reduction in BRS has furthermore been repeatedly reported by different studies in type 1 and type 2 diabetic patients [9,11,12,15]. Our findings also support these previous data, but, importantly, do so even in the absence of clinical complications or in the absence of alterations in the autonomic function tests.…”

Section: Discussionmentioning

confidence: 97%

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Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

et al. 2009

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Aims/hypothesis Cardiac autonomic neuropathy is associated with increased morbidity and mortality rates in patients with type 1 diabetes. The prevalence of early autonomic abnormalities is relatively high compared with the frequency of manifest clinical abnormalities. Thus, early autonomic dysfunction could to some extent be functional and might lead to an organic disease in a subgroup of patients only. If this is true, manoeuvres such as slow deep-breathing, which can improve baroreflex sensitivity (BRS) in normal but not in denervated hearts, could also modify autonomic modulation in patients with type 1 diabetes, despite autonomic dysfunction.Methods We compared 116 type 1 diabetic patients with 36 matched healthy control participants and 12 hearttransplanted participants with surgically denervated hearts. Autonomic function tests and spectral analysis of heart rate and blood pressure variability were performed. BRS was estimated by four methods during controlled (15 breaths per minute) and slow deep-breathing (six breaths per minute), and in supine and standing positions. Results Conventional autonomic function tests were normal, but resting spectral variables and BRS were reduced during normal controlled breathing in patients with type 1 diabetes. However, slow deep-breathing improved BRS in patients with type 1 diabetes, but not in patients with surgically denervated hearts. Standing induced similar reductions in BRS in diabetic and control participants. Conclusions/interpretation Although we found signs of increased sympathetic activity in patients with type 1 diabetes, we also observed a near normalisation of BRS with a simple functional test, indicating that early autonomic derangements are to a large extent functional and potentially correctable by appropriate interventions.

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Section: Discussionmentioning

confidence: 97%

“…A high prevalence of CAN, reduced HRV and blunted spontaneous BRS in patients with type 1 as well as in patients with type 2 diabetes have been reported previously [9][10][11][12][13][14][15]. It is of note that the tests used allow early detection of abnormalities in the autonomic nervous system.…”

Section: Introductionmentioning

confidence: 90%

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

et al. 2009

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“…Data from adult diabetic patients indicate that an impairment in baroreceptor sensitivity (BRS) may be involved in the development of systemic hypertension in diabetes [5][6][7]. The baroreflex itself describes a complex regulatory circuit that consists of afferent receptors located in the aorta and carotid arteries (high-pressure baroreceptors) and in the right atrium and pulmonary artery (low-pressure baroreceptors) signalling through non-myelinated nerve fibres to the circulatory centres in the medulla oblongata.…”

Section: Introductionmentioning

confidence: 99%

“…The LF/HF ratio is indicative of sympathovagal balance. Autonomic dysbalance has been shown to precede autonomic neuropathy in adult diabetic patients [5] and has been attributed to abnormality of parasympathetic function.…”

Section: Introductionmentioning

confidence: 99%

Impaired short-term blood pressure regulation and autonomic dysbalance in children with type 1 diabetes mellitus

et al. 2007

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Aims Because reduction in baroreceptor sensitivity (BRS) has been associated with hypertension in the normal population and with increased cardiovascular morbidity and mortality in patients with diabetes mellitus, we measured BRS in a patient cohort of children with type 1 diabetes mellitus. Methods Two hundred and eight children (150 patients with type 1 diabetes mellitus, mean age 13.9±2.8 years, 70 boys, mean HbA 1c 7.8±1.4%; and 58 healthy controls, mean age 14.1±3.1 years, 32 boys) were studied. BRS and heart rate variability (HRV) were analysed from a shorttime ECG and BP recording using the sequence method (BRS) and the frequency domain method (HRV). Results There were 111 of 150 patients (74%) and 5 of 58 controls (8.6%) that showed impaired BRS. Mean BRS differed significantly between patients and controls (18.4± 7.2 vs 25.8 ± 8.2 ms/mm, p < 0.001). BRS correlated inversely with systolic BP (r=−0.23, p=0.009) and was related to diabetes duration (r=−0.194, p=0.027). Analysis of HRV showed greater sympathetic and less parasympathetic influence in patients than in controls (low frequency/ high frequency ratio 1.3±0.8 vs 0.9±0.6, p<0.05); the low frequency/high frequency ratio was inversely correlated with BRS (r=−0.28, p=0.001). Conclusions/interpretation Diabetic children show reduced BRS. In our patient group, the single risk factor for this finding was found to be the disease duration. The degree of BRS impairment was related to the degree of autonomic dysbalance.

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“…While changes in autonomic control have been linked to several chronic diseases and disorders, the large fluctuations in blood glucose levels associated with Type 1 diabetes mellitus (T1DM) tend to place these patients at particularly greater risk [3]. The impairment in ANS function associated with T1DM has been noted in numerous studies, even in those patients who appear to be otherwise ''healthy'' (i.e., no diagnosed retinopathy, nephropathy, or clinical neuropathy) [11,12]. A recently published study by Limberg et al [8] not only eloquently highlights how ANS function is impaired in patients with T1DM at rest, but also how factors as simple as glycemic management can exacerbate impairments in autonomic control.…”

mentioning

confidence: 99%