Key result
Uncomplicated T1DM linked to ~9 mmHg higher supine SBP and greater sympathetic activation versus healthy controls.
Why the study?
Cardiovascular autonomic neuropathy remains underdiagnosed in type 1 diabetes mellitus, and this study aimed to determine whether heart rate variability during reflex tests reveals early signs in patients with uncomplicated disease and normal cardiovascular fitness.
Do patients with uncomplicated type 1 diabetes mellitus and normal V̇O2max exhibit altered cardiovascular autonomic function during orthostatic testing compared to healthy controls?
Cross-Sectional (n=45)
No
Do patients with uncomplicated type 1 diabetes mellitus and normal V̇O2max exhibit altered cardiovascular autonomic function during orthostatic testing compared to healthy controls?
Patients with uncomplicated type 1 diabetes and normal cardiorespiratory fitness exhibit subclinical cardiovascular autonomic dysfunction, characterized by higher systolic blood pressure and greater sympathetic activation during orthostatic stress.
May indicate subclinical autonomic changes warranting monitoring in fit type 1 diabetes patients; hypothesis-generating and leaves open prognostic value.
Purpose Cardiovascular autonomic neuropathy remains underdiagnosed in type 1 diabetes mellitus, posing a risk for severe complications, particularly in patients with lowered V̇O 2max , compared to controls. This study aimed to determine whether heart rate variability during cardiovascular autonomic reflex tests reveals early signs of cardiovascular autonomic neuropathy in patients with uncomplicated type 1 diabetes mellitus and normal cardiovascular fitness, compared to healthy controls. Methods A type 1 diabetes mellitus group ( n = 14) with no other diagnosed diseases (diabetes duration 15 ± 7 years) and a control group ( n = 31) underwent deep breathing test, passive orthostatic test, and cardiopulmonary exercise test. Participants were assessed for heart rate variability, heart rate, blood pressure, and V̇O 2max (mL/min/kg). Results Participant characteristics, including V̇O 2max (mL/min/kg), showed no significant differences. The type 1 diabetes mellitus group had higher systolic blood pressure during the supine phase of the orthostatic test than healthy controls (131.6 ± 14.7 mmHg vs. 122.4 ± 10.8 mmHg, p = 0.022). After 5 mins in the upright position, systolic blood pressure (132.2 ± 20.6 mmHg vs. 118.7 ± 11.7 mmHg, p = 0.036), heart rate (85 (76; 89) bpm vs. 75 (72; 83) bpm, p = 0.013), and the root mean square of successive RR interval differences (20.22 (11.22; 27.42) vs. 27.11 (19.90; 35.52), p = 0.033) were significantly different compared to controls. Conclusion Patients with uncomplicated type 1 diabetes mellitus, despite having normal cardiorespiratory fitness, exhibited higher systolic pressure and greater sympathetic activation in orthostatic tests, suggesting subclinically altered cardiovascular autonomic function.
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Sorola et al. (2024) conducted a cross-sectional in Uncomplicated type 1 diabetes mellitus (n=45). Type 1 diabetes mellitus vs. Healthy controls was evaluated on Systolic blood pressure during the supine phase of the orthostatic test (mmHg) (Mean difference 9.3, 95% CI 1.4-17.1, p=0.022). Patients with uncomplicated type 1 diabetes mellitus and normal cardiorespiratory fitness exhibited higher supine systolic blood pressure and greater sympathetic activation during orthostatic tests compared to healthy controls.
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