Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

Young, Robert J.; MacIntyre, Cecilia; Martyn, Christopher; Prescott, R. J.; Ewing, D J; Smith, A. F.; Viberti, Giancarlo; Clarke, B F

doi:10.1007/bf02427086

Cited by 85 publications

(50 citation statements)

References 41 publications

(42 reference statements)

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“…Puberty impairs insulin action both in patients with type 1 diabetes and in healthy adolescents (8), and our findings are largely in accordance with the obser- vation that poor metabolic control is the most important prognostic factor for neuronal dysfunction both in adolescent (2,20) and adult patients (7,21). The peripheral and autonomic nerve fibers of pubertal and postpubertal patients with diabetes may be the most vulnerable to nerve demyelination and axonal damage caused by poor metabolic control induced by the pubertal hormonal changes (8) and presumably also by poor motivation for self-care during puberty.…”

Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 90%

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Riihimaa

Suominen²,

Tolonen³

et al. 2001

Diabetes Care

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OBJECTIVE -To evaluate the impact of puberty on peripheral nerve function in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Of 138 eligible patients with type 1 diabetes, 100 patients (age Ͼ9 years and diabetes duration Ͼ2 years) attending an outpatient diabetes clinic and 100 age-and sex-matched healthy control subjects took part in this cross-sectional study. Peripheral motor and sensory nerve conduction tests, cardiovascular reflex tests on the autonomic nervous system, and measurements of vibration-perception threshold (VPT) were performed.RESULTS -Nerve conduction velocity (NCV) in the distal motor and sensory nerves, the motor nerve distal latency, and the sensory nerve action potential (SNAP) amplitude were impaired in the adolescent patients with type 1 diabetes. The deterioration in motor NCV, H-reflex latency, and SNAP amplitude became more conspicuous in late puberty and postpuberty and was related to poor metabolic control. A total of 10 patients had distal diabetic polyneuropathy (DP) neurophysiologically, and these patients had significantly lower heart-rate variation in the deep breathing test than the other patients. Three of the patients with DP had peripheral neurological signs or symptoms. A slight difference in the VPT between the patients and control subjects was observed after puberty.CONCLUSIONS -Increasing subclinical motor nerve impairment can be detected during late puberty and after puberty, and sensory NCV and SNAP amplitude are reduced in adolescents with type 1 diabetes. Poor metabolic control during puberty appears to induce deteriorating peripheral neural function in young patients with type 1 diabetes.

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Section: Table 3-h-reflex Latency Difference (Milliseconds) In the Tisupporting

confidence: 90%

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Riihimaa

Suominen²,

Tolonen³

et al. 2001

Diabetes Care

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“…Tightening control in early pregnancy inevitably increases the frequency of hypoglycaemia. Recent work with rats has shown that hypoglycaemia at a critical stage of development-namely, equivalent to days 32-40 in humans (18)(19)(20)(21)(22)(23)(24)(25)(26) days after ovulation)-can cause congenital abnormalities.1316 Hence the desirability of reducing blood glucose concentrations in early pregnancy has been questioned. 16 This paper reports the first 14 years' experience of our prepregnancy clinic, comparing results in women who attended the clinic with those in a group of women who did not.…”

Section: Introductionmentioning

confidence: 99%

Can prepregnancy care of diabetic women reduce the risk of abnormal babies?

Steel

Johnstone²,

Hepburn³

et al. 1990

BMJ

185

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controlled for in the multivariate analvsis. Furthermore, the suggested risk factors occurring later in life, such as psychological mechanisms and drug availability and exposition, cannot explain the demonstrated associations between administration of drugs during the perinatal period and subsequent addiction in offspring. Also, genetic and socioeconomic factors were largely controlled for by matching addicts with their own siblings.In conclusion, effective pain relief is sometimes an important factor for a successful outcome of delivery, as well as for the ability of the mother to accept and care for the child in the future. At present, when considering the choice of analgesic method immediate risks and benefits are mainly taken into account. When depressant or sedative drugs are used their possible long term effects due to imprinting also seem to be important. From this point of view, analgesic methods not associated with passage of substantial amounts of drugs across the placenta are preferable. Our Abstract Objective-To see whether a prepregnancy clinic for diabetic women can achieve tight glycaemic control in early pregnancy and so reduce the high incidence of major congenital malformation that occurs in the infants of these women. Design-An analysis of diabetic control in early pregnancy including a record of severe hypoglycaemic episodes in relation to the occurrence of major congenital malformation among the infants.Setting-A diabetic clinic and a combined diabetic and antenatal clinic of a teaching hospital.Patients -143 Insulin dependent women attending a prepregnancy clinic and 96 insulin dependent women managed over the same period who had not received specific prepregnancy care.Main outcome measure-The incidence of major congenital malformation.Results-Compared with the women who were not given specific prepregnancy care the group who attended the prepregnancy clinic had a lower haemoglobin Al concentration in the first trimester (8.4% v 10-5%), a higher incidence of hypoglycaemia in early pregnancy (38/143 women v 8/96), and fewer infants with congenital abnormalities (2/143 v 10/96; relative risk among women not given specific prepregnancy care 7-4 (95% confidence interval 1-7 to 33.2)).Conclusion-Tight control of the maternal blood glucose concentration in the early weeks of pregnancy can be achieved by the prepregnancy clinic approach and is associated with a highly significant reduction in the risk of serious congenital abnormalities in the offspring. Hypoglycaemic episodes do not seem to lead to fetal malformation even when they occur during the period of organogenesis.

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“…21,22 Young et al 21 reported that the deterioration of motor, sensory, and autonomic nerve function over 2.5 years among 75 adolescents with T1D was related to poor glycemic control. In a small clinic-based crosssectional study of 79 children with T1D, Chen et al 22 found that both A1c and duration were significant predictors of reduced HRV as measured by HF power.…”

mentioning

confidence: 99%

Impact of Glycemic Control on Heart Rate Variability in Youth with Type 1 Diabetes: The SEARCH CVD Study

Jaiswal

Fingerlin

Urbina

et al. 2013

Diabetes Technology & Therapeutics

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Aim: This study explored the role of glycemic control on cardiac autonomic function, measured by heart rate variability (HRV), in youth with type 1 diabetes. Patients and Methods: A retrospective cohort of 345 youth with type 1 diabetes (mean age, 18.5 years; duration, 10 years) participating in the SEARCH for Diabetes in Youth study were enrolled in the ancillary SEARCH Cardiovascular Disease (CVD) study. Anthropometric, metabolic, and HRV parameters were collected at the current research visit. Glycemic control over time was assessed by the mean glycated hemoglobin (A1c) levels collected over the past 6 years. Multiple linear regression analysis assessed the association between A1c over time and HRV parameters, independent of demographic and CVD risk factors. Participants were categorized into four glycemic control categories based on their mean A1c over time: Group 1, optimal (mean A1c, £ 7.4%); Group 2 (mean A1c, 7.5-8.4%); Group 3 (mean A1c, 8.5-9.4%), and Group 4, poor (mean A1c, ‡ 9.5%), and a linear trend was explored across these categories. Results: For every 1% increase in the average A1c over 6 years there was a 5% decrease in the SD of the normal RR interval (SDNN) (P = 0.02) and 7% decrease in the root mean square successive difference of the RR interval (RMSSD) (P = 0.02), independent of demographic and traditional CVD risk factors. A dose-response relationship between worsening glucose control categories and measures of overall reduced HRV was found. Conclusions: Chronic hyperglycemia is the main determinant of early cardiac autonomic dysfunction, manifested as reduced overall HRV and parasympathetic loss, among youth with type 1 diabetes.

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Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications)

Cited by 85 publications

References 41 publications

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Peripheral Nerve Function Is Increasingly Impaired During Puberty in Adolescents With Type 1 Diabetes

Can prepregnancy care of diabetic women reduce the risk of abnormal babies?

Impact of Glycemic Control on Heart Rate Variability in Youth with Type 1 Diabetes: The SEARCH CVD Study

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