Key result
Higher Valsalva HR response predicts ~2% annual ACR increase in youth with type 1 diabetes.
Why the study?
The potential role of cardiovascular autonomic dysfunction in the development of renal complications in young people with type 1 diabetes was unclear.
Does cardiovascular autonomic dysfunction predict future increases in urine albumin-creatinine ratio in young people with type 1 diabetes?
Cohort (n=199)
Does cardiovascular autonomic dysfunction predict future increases in urine albumin-creatinine ratio in young people with type 1 diabetes?
Effect estimate: 2.16% increase per year per SD (95% CI 0.08-4.28)
p-value: p=0.04
Enhanced cardiovascular reflexes at baseline predict future increases in albumin excretion in young people with type 1 diabetes, suggesting a role for autonomic dysfunction in diabetic nephropathy.
Objective To determine the potential role of cardiovascular autonomic dysfunction in the development of renal complications in young people with type 1 diabetes (T1D). Methods In this prospective study, 199 children and adolescents recruited to the Oxford Regional Prospective Study underwent assessment of autonomic function ~5 years after diagnosis, and were subsequently followed with longitudinal assessments of HbA1c and urine albumin-creatinine ratio (ACR) over 8.6 ± 3.4 years. Autonomic function was assessed with 4 standardized tests of cardiovascular reflexes: heart rate (HR) response to (1) Valsalva Maneuver, (2) deep breathing, (3) standing, and (4) blood pressure (BP) response to standing. Linear mixed models were used to assess the association between autonomic parameters and future changes in ACR. Results Independent of HbA1c, each SD increase in HR response to Valsalva Maneuver predicted an ACR increase of 2.16% [95% CI: 0.08; 4.28] per year (P = .04), while each SD increase in diastolic BP response to standing predicted an ACR increase of 2.55% [95% CI: 0.37; 4.77] per year (P = .02). The effect of HR response to standing on ACR reached borderline significance (−2.07% [95% CI: −4.11; 0.01] per year per SD increase, P = .051). Conclusions In this cohort of young people with T1D, enhanced cardiovascular reflexes at baseline predicted future increases in ACR. These results support a potential role for autonomic dysfunction in the pathogenesis of diabetic nephropathy.
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Lu et al. (2017) conducted a cohort in type 1 diabetes (n=199). Cardiovascular autonomic dysfunction was evaluated on future changes in urine albumin-creatinine ratio (ACR) (2.16% increase per year per SD, 95% CI 0.08-4.28, p=0.04). Each SD increase in heart rate response to Valsalva Maneuver predicted a 2.16% per year increase in urine albumin-creatinine ratio (95% CI 0.08-4.28; P=0.04) in youth with type 1 diabetes.
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