Higher frequency of cardiovascular autonomic neuropathy in youth with type 2 compared to type 1 diabetes: Role of cardiometabolic risk factors

Background Cardiovascular autonomic neuropathy (CAN) is an overlooked but common and serious diabetes complication. We examined CAN in youth with diabetes and associations with cardiovascular risk factors. Methods This was a prospective cohort of youth aged <20 years with type 2 or type 1 diabetes (n=66/1153, median age 15.4/16.5 years, duration 1.7/8.0 years), assessed between 2009-2020. CAN was defined as ≥2 abnormal heart rate variability measures across time, geometric, and frequency domains. Obesity was defined as BMI ≥95th percentile and severe obesity as ≥120% of 95th percentile. Multivariable generalized estimating equations (GEE) were used to examine putative risk factors for CAN, including diabetes type, obesity and HbA1c. Results At most recent assessment, youth with type 2 vs type 1 diabetes had median: HbA1c 7.1% (54 mmol/mol) vs 8.7% (72 mmol/mol) and BMI SDS (2.0 vs 0.7); frequency of CAN (47% vs 27%), peripheral nerve abnormality (47% vs 25%), hypertension (29% vs 12%), albuminuria (21% vs 3%), and severe obesity (35% vs 2%). In multivariable GEE, CAN was associated with type 2 diabetes: Odds Ratio 2.53, 95% CI 1.46, 4.38, p=0.001, higher BMI SDS: 1.49, 95% CI 1.29, 1.73, p<0.0001, and obesity: 2.09, 95% CI 1.57, 2.78, p<0.0001. Conclusions Youth with type 2 diabetes have a higher frequency of CAN, peripheral nerve abnormality, hypertension, albuminuria and severe obesity despite shorter diabetes duration and younger age. Our findings highlight the importance of targeting modifiable risk factors to prevent cardiovascular disease in youth with diabetes. This article is protected by copyright. All rights reserved.