Prospective Assessment of Autonomic and Peripheral Nerve Function in Adolescents with Diabetes

Donaghue, Kim C.; Fung, A. T. W.; Fairchild, Jan; Howard, Neville J.; Silink, Martin

doi:10.1002/(sici)1096-9136(199601)13:1<65::aid-dia997>3.0.co;2-w

Cited by 44 publications

(23 citation statements)

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“…In an earlier study by Donaghue et al, approximately one-third of diabetic adolescents had one or more abnormal autonomic function tests, including reduced heart rate variability and/or a significant postural drop in blood pressure when compared to healthy controls . However, only a small proportion (6/102) of adolescents had persistent autonomic abnormalities at a 5 year follow-up (Donaghue et al, 1996). Using a modified criterion of more than 2.5% the upper limit of normal, 13% of adolescents with T1D had at least one autonomic abnormality at baseline, which increased modestly to 16% after 5 years of follow-up (Donaghue, 1998).…”

Section: Autonomic Function Testmentioning

confidence: 96%

Diabetic neuropathy in children

Mah

Pacaud

2014

Diabetes and the Nervous System

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Section: Autonomic Function Testmentioning

confidence: 96%

Diabetic neuropathy in children

Mah

Pacaud

2014

Diabetes and the Nervous System

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“…Peripheral nerve function was assessed by thermal threshold testing for hot and cold at the left foot (Thermal Threshold Tester; Medelec, Old Woking, Surrey, U.K.) and vibration threshold at the left medial malleolus and left great toe (Biothesiometer; Biomedical Instrument, Newbury, OH) (12,21). Pupillary abnormalities and peripheral nerve abnormalities were defined as Ͻ5% of the normal range in a nondiabetic adolescent control group previously tested in our laboratory (22,23).…”

Section: Research Design Andmentioning

confidence: 99%

Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes

et al. 2006

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OBJECTIVE -To compare the prevalence of diabetes complications and their risk factors in youth with type 1 versus type 2 diabetes.RESEARCH DESIGN AND METHODS -We performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged Ͻ18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoscopic retinal photography; albumin excretion rate from three consecutive, timed, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA 1c (A1C) and lipids were measured in all patients and C-peptide in patients with type 2 diabetes.RESULTS -In patients with type 1 versus type 2 diabetes, median (interquartile range) age was 15.7 years (13.9 -17.0) and 15.3 years (13.6 -16.4), respectively (P ϭ 0.2), whereas median diabetes duration was 6.8 years (4.7-9.6) and 1.3 years (0.6 -3.1), respectively (P Ͻ 0.0001). Retinopathy was significantly more common in patients with type 1 diabetes (20 vs. 4%, P ϭ 0.04), while microalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes). In multivariate analyses, microalbuminuria was significantly associated with older age (odds ratio 1.3 [95% CI 1.2-1.5], P Ͻ 0.001) and systolic hypertension (3.63 [2.0 -6.3], P Ͻ 0.001) in type 1 diabetes, while only higher A1C (1.7 [1.3-2.9], P ϭ 0.002) was significant in patients with type 2 diabetes.CONCLUSIONS -Youth with type 2 diabetes have significantly higher rates of microalbuminuria and hypertension than their peers with type 1 diabetes, despite shorter diabetes duration and lower A1C. The results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes. Diabetes Care

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“…Although physiological maturation during adolescence is connected with the pubertal stages more closely than with age, maturation according to the Tanner pubertal stages is seldom taken into account (10,12), while age has been used as a marker of puberty in earlier power spectral analysis of HRV and blood pressure (9,(55)(56)(57). Pubertal staging permits closer and more accurate observation of clinical and research variables.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Subclinical autonomic dysfunction can, however, occur within a year of diagnosis in type 2 diabetes patients and within 2 years in patients with type 1 diabetes (5). There is controversy over whether subclinical signs of autonomic dysfunction can be found in children with diabetes (8)(9)(10)(11)(12)(13)(14)(15). Because of its association with adverse outcomes, including cardiovascular deaths, cardiovascular autonomic neuropathy (CAN) is the most clinically important and well-studied form of DAN.…”

Section: Introductionmentioning

confidence: 99%

New insights in diabetic autonomic neuropathy in children and adolescents

Verrotti

Loiacono

Mohn

et al. 2009

European Journal of Endocrinology

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Diabetic autonomic neuropathy (DAN) represents a major complication of diabetes mellitus but there is considerable uncertainty about its incidence, prevalence, pathogenesis, diagnosis, and prognosis. There are conflicting opinions about the pathogenesis of DAN: the 'classical hypothesis' has been supplemented by some new insights. Clinical symptoms of autonomic neuropathy do not generally occur until long after the onset of diabetes. DAN seems to be detectable even in asymptomatic children and adolescents with diabetes and is associated with the most serious consequences, such as cardiovascular dysfunction. Because of its association with a variety of adverse outcomes, including cardiovascular deaths, cardiovascular autonomic neuropathy is the most clinically important and well-studied form of DAN. No form of therapy in DAN has been identified that provides unequivocal, safe, and effective stabilization or reversal of the condition, just a near normal control of blood glucose in the early years after the onset of diabetes that may delay the development of clinically significant nerve impairment. This article reviews recent developments in knowledge of epidemiology, pathogenesis, clinical symptoms, diagnosis, and therapy of DAN.

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Prospective Assessment of Autonomic and Peripheral Nerve Function in Adolescents with Diabetes

Cited by 44 publications

References 0 publications

Diabetic neuropathy in children

Diabetic neuropathy in children

Prevalence of Diabetes Complications in Adolescents With Type 2 Compared With Type 1 Diabetes

New insights in diabetic autonomic neuropathy in children and adolescents

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