Pediatric Diabetes

 Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes
Background Obesity is associated with an increased risk of cardiovascular morbidity in adults with diabetes. Objective To examine the predictive role of body mass index (BMI) and adiposity on cardiac autonomic function in childhood onset type 1 diabetes. Subjects Two hundred and fifty-three participants with type 1 diabetes (aged 8-30 years) were assessed for diabetes complications at a tertiary hospital, and followed over 7?years (total 922 visits). Methods Heart rate variability (HRV) measures assessed by 10-minute electrocardiography recording using LabChart Pro were standard deviation of RR intervals, time between consecutive QRS complexes, [SDNN], root mean squared difference of successive RR intervals (RMSSD), triangular index (TI), and low to high frequency ratio [LF:HF]. Multivariable generalized estimating equations were used to model the longitudinal associations between HRV measures and clinical variables (BMI standard deviation scores [SDS], waist:height ratio, total daily insulin dose/kg (TDD) and hemoglobin A1c [HbA1c]). Results At baseline, mean age was 14.4?±?2.7?years, diabetes duration 7.1?±?3.7?years, HbA1c 8.3%?±?1.5% (67?±?16?mmol/mol), and 33% were overweight/obese (BMI ?85th percentile). At final visit, mean age was 18.5?±?2.7?years, duration 11.3?±?3.9?years, HbA1c 9.0%?±?1.8% (75?±?20?mmol/mol), and 40% were overweight/obese. Adiposity (higher BMI SDS or waist: height ratio) was a significant predictor of worse HRV (lower SDNN, RMSSD; P?