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dc.contributor.authorCho, Yoon Hien
dc.contributor.authorCraig, Maria Een
dc.contributor.authorDavis, Elizabeth Aen
dc.contributor.authorCotterill, Andrewen
dc.contributor.authorCouper, Jennifer Jen
dc.contributor.authorCameron, Fergus Jen
dc.contributor.authorBenitez-Aguirre, Paul Zen
dc.contributor.authorDalton, R Neilen
dc.date.accessioned2015-08-06T13:09:45Z
dc.date.available2015-08-06T13:09:45Z
dc.date.issued2015-01-08en
dc.identifier.citationCho et al. Diabetes Care (2015) Vol. 38 Issue 4, pp. 676-681 . DOI: 10.2337/dc14-1848en
dc.identifier.issn0149-5992
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/249224
dc.description.abstractObjective: To examine the association between cardiac autonomic dysfunction and high albumin:creatinine ratio (ACR) in adolescents with type 1 diabetes. Research Design and Methods: Adolescents recruited as part of a multicentre screening study (n=445, 49% female, aged 10-17 years, mean duration 6.9 years, mean HbA1c 8.4%, 68mmol/mol) underwent a 10-minute continuous ECG-recording for heart rate variability analysis. Time domain heart rate variability measures included: baseline heart rate, SDNN (standard deviation of the R-R interval), RMSSD (root mean squared difference of successive RR intervals); and spectral analysis included: sympathetic (low frequency) and parasympathetic (high frequency) components. Standardised ACR were calculated from 6 early morning urine collections using an established algorithm, reflecting age, gender and duration, and stratified into ACR tertiles where the upper tertile reflects higher nephropathy risk. Results: The upper tertile ACR group had faster heart rate (76 vs 73bpm; p<0.01) and less heart rate variability (SDNN 68 vs 76ms, p=0.02; RMSSD 63 vs 71ms, p=0.04). HbA1c was 8.5% (69 mmol/mmol) in the upper tertile vs 8.3% (67mmol/mol) in the lower tertiles (p=0.07). In multivariable analysis, upper tertile ACR was associated with faster heart rate (β=2.5, CI 0.2 to 4.8; p=0.03) and lower RMSSD (β=-9.5, CI -18.2 to -0.8; p=0.03), independent of age and HbA1c. Conclusions: Adolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared to the lower risk group. Longitudinal follow up of this cohort will further characterize the relationship between autonomic and renal dysfunction, and the impact of interventions in this population.
dc.description.sponsorshipNational Health and Medical Research Council, Australia (NHMRC) 632521, Australasian Paediatric Endocrine Group (APEG), Juvenile Diabetes Research Foundation, British Heart Foundation, Diabetes UK.
dc.languageEnglishen
dc.language.isoenen
dc.publisherAmerican Diabetes Association
dc.titleCardiac autonomic dysfunction is associated with high risk albumin: creatinine ratio in young adolescents with type 1 diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)en
dc.typeArticle
dc.description.versionThis is the accepted manuscript. The final version is available at http://care.diabetesjournals.org/content/early/2015/01/01/dc14-1848.en
prism.endingPage681
prism.publicationDate2015en
prism.publicationNameDiabetes Careen
prism.startingPage676
prism.volume38en
dc.rioxxterms.funderBHF
rioxxterms.versionofrecord10.2337/dc14-1848en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2015-01-08en
dc.identifier.eissn1935-5548
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idDiabetes UK (06/0003341)
pubs.funder-project-idBritish Heart Foundation (via University College London (UCL)) (07CC14)
pubs.funder-project-idJuvenile Diabetes Research Foundation Ltd (JDRF) (8-2007-902)
pubs.funder-project-idDiabetes UK (DUK-06/0003341)


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