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(Hypertension. 2009;54:987.)
© 2009 American Heart Association, Inc.

Original Articles

Early Progression of the Autonomic Dysfunction Observed in Pediatric Type 1 Diabetes Mellitus

Daniela Lucini; Gianvincenzo Zuccotti; Mara Malacarne; Andrea Scaramuzza; Sara Riboni; Carlo Palombo; Massimo Pagani

From the Centro Ricerca Terapia Neurovegetativa (D.L., M.M., M.P.) and Department of Clinical Sciences (D.L., G.Z., M.P.), University of Milan, Milan, Italy; Department of Pediatrics (G.Z., A.S., S.R., M.P.), L Sacco Hospital, Milan, Italy; Department of Internal Medicine (C.P.), University of Pisa, Pisa, Italy.

Correspondence to Massimo Pagani, UO Telemedicina e Medicina Dello Sport, Ospedale L Sacco, Universita’ di Milano, via GB Grassi 74, 20157 Milano, Italy. E-mail mp{at}ctnv.unimi.it

To focus on early cardiac and vascular autonomic dysfunction that might complicate type 1 diabetes mellitus in children, we planned an observational, cross-sectional study in a population of 93 young patients, under insulin treatment, subdivided in 2 age subgroups (children: 11.5±0.4 years; adolescents: 19.3±0.2 years). Time and frequency domain analysis of RR interval and systolic arterial pressure variability provided quantitative indices of the sympatho-vagal balance regulating the heart period, of the gain of cardiac baroreflex, and of the sympathetic vasomotor control. Sixty-eight children of comparable age served as a reference group. At rest, systolic arterial pressure and the power of its low-frequency component were greater in patients than in controls, particularly in children (14.0±2.3 versus 3.1±0.3 mm Hg²). Moreover, baroreflex gain was significantly reduced in both subgroups of patients. Standing induced similar changes in the autonomic profiles of controls and patients. A repeat study after 1 year showed a progression in low-frequency oscillations of arterial pressure and a shift toward low frequency in RR variability. Data in young patients with type 1 diabetes mellitus show a significant increase in arterial pressure, a reduced gain of the baroreflex regulation of the heart period, and an increase of the low-frequency component of systolic arterial pressure variability, suggestive of simultaneous impairment of vagal cardiac control and increases of sympathetic vasomotor regulation. A repeat study after 1 year shows a further increase of sympathetic cardiac and vascular modulation, suggesting early progression of the autonomic dysfunction.

Key Words: autonomic nervous system • baroreflex • children • diabetes mellitus • sympathetic nervous system • vasculature