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Relationship of hypoglycemia and glucose variability with autonomic dysfunction in children and adolescents with type 1 diabetes

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Abstract


Aim.
Glucose variability (GV) and hypoglycaemia frequency and duration, depending on cardiovascular autonomic dysfunction, in children and adolescents with type 1 diabetes mellitus (T1DM) were evaluated.
Materials and methods.
One hundred and thirty T1DM patients, aged 6?18 years, were included in this study. The study included 3 tests:.
  1. continuous glucose monitoring (CGM) with GV evaluation, frequency and duration of hypoglycaemia;
  2. 24-h ECG monitoring with automatic calculation of QTc interval and heart rate variability (HRV) parameters;
  3. cardiovascular autonomic tests.
Results.
The estimated prevalence of cardiovascular autonomic neuropathy (CAN) was 19.2%. CAN positive (CAN+) patients had lower values from cardiovascular autonomic tests and HRV and longer QTc intervals compared with CAN negative (CAN-) patients (p <0.05). The median of glucose levels was independent of CAN. GV as well as time spent in hypoglycaemia (<3.9 mmol/l) were increased in CAN+ patients, but not the duration of hyperglycaemia (>10 mmol/l) (p <0.05). In CAN+ patients, the frequency and duration of hypoglycaemia were higher compared with CAN- patients (p <0.05). GV and hypoglycaemia were positively associated with autonomic dysfunction in multiple regression models (p <0.05).
Conclusion.
In this study, the presence of CAN was associated with increased GV and higher hypoglycaemia frequency and duration. This data suggest that GV and/or hypoglycaemia may contribute to impaired cardiovascular autonomic function. This can have an impact on the determination of individual blood glucose targets in patients with T1DM and CAN.

Dmitriy Nikitich Laptev

Endocrinology Research Centre, Moscow

Author for correspondence.
Email: laptevdn@ya.ru

Russian Federation MD, PhD, Senior scientist, Pediatric Endocrinology Institute of Endocrinology Research Centre

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