Cardiovascular Reflex Abnormalities in Children and Adolescents With Diabetes Mellitus
- Richard E Ringel, MD,
- Stuart A Chalew, MD,
- Karen A Armour, MD,
- Judith McLughun, MD,
- Robert J McCarter jr, SCD and
- Wendy E Kramer, BA
- Divisions of Pediatric Cardiology and Pediatric Endocrinology, Department of Pediatrics; and the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine Baltimore, Maryland
- Address correspondence and reprint requests to Stuart A. Chalew, MD, University of Maryland, UMH, N5E13, Box 264, 22 S. Greene Street, Baltimore, MD 21201.
Abstract
OBJECTIVE To assess the usefulness of specific cardiovascular reflex tests in childhood and to estimate the prevalence of cardiovascular reflex abnormalities among children with IDDM. In adults, abnormal cardiovascular reflexes are a frequent complication of diabetes, associated with increased morbidity and mortality.
RESEARCH DESIGN AND METHODS We measured heart-rate responses to deep breathing and standing in ambulatory children with and without IDDM between 6–19 yr of age. A subgroup of the IDDM patients was retested after 1 yr.
RESULTS We found the best techniques for detecting cardiovascular reflex abnormality in children were as follows: to record heart-rate responses to deep breathing either as the change inheart rate corrected for inspiratory heart rate or as the ratio of R-R intervals during expiration and inspiration; and to use the Maximum-minimum ratio for heart-rate responses to standing. HR-DBC was lower in diabetic than nondiabetic children (28.6 ± 9.2% [n = 248] vs. 33.6 ± 6.8% [n = 60]; P < 0.0005). Similarly, E:I was lower in children with IDDM than control subjects (1.42 ± 0.19 [n = 248] vs. 1.52 ± 0.15 [n = 60]; P < 0.0005). In the IDDM group, 21% of the children had abnormal HR-DBc or E:I responses. HR-STND M/m was lower in children with IDDM than control subjects (1.28 ± 0.20 [n = 167] vs. 1.38 ± 0.22 [n = 45]; P < 0.014). Among children with IDDM, 11.4% had abnormal HR-STND M/m responses. Overall, 29% of IDDM children tested abnormal in either HR-DBC or HR-STND M/m; 3% were abnormal in both tests. We found no correlation of HbA1c levels (n = 74) or duration of diabetes with either HR-DB, expiration to inspiration (n = 248), or HR-STND M/m (n = 167). In patients who were reevaluated after 1 yr we found a high correlation of the first and repeat HR-DBC tests (r = 0.47, n = 75, P < 0.0001), E:I (r = 0.53, n = 75, P < 0.0001), and HR-STND M/m (r = .49, n = 37, P < 0.002), but no evidence of an increased number of children with cardiovascular reflex abnormality.
CONCLUSIONS With easily performed HR-DB and HR-STND tests, we detected cardiovascular reflex abnormality in 29% of children with IDDM. We found no correlation of changes in HR-DB and HR-STND with HbA1c or duration of diabetes. These tests provide an objective clinical measurement to monitor autonomic neuropathy in children with diabetes.
- Received June 15, 1992.
- Revision received January 21, 1993.
- Accepted January 21, 1993.
- Copyright © 1993 by the American Diabetes Association
