Miriam Čiljaková, Jarmila Vojtková, Lenka Vojarová, Katarína Klabniková, Peter Ďurdík, Peter Bánovčin
Introduction: Autonomic neuropathy is one of the most serious and frequent complication of diabetes mellitus. The prevalence of diabetic autonomic neuropathy (DAN) varies in aspect to different criteria used for diagnosis from study to study. Parasymphathetic dysfunction is considered to be an early sign of DAN. Objective of study: The objective of the study was to assess the prevalence of autonomic neuropathy in adolescents with type 1 diabetes and to evaluate the risk factors responsible for early development of diabetic autonomic neuropathy. Patients and methods: A total of 61 patients (37 girls, 24 boys) aged 14-19 with type 1 diabetes were examined. Diabetes duration, onset, anthropometric parameters (BMI), laboratory parameters (serum glucose, HbA1c, triglycerides, total cholesterol, microalbuminuria), parameters of heart rate variability (I/E, CV RR) were evaluated. According to the results of heart rate variability in deep breathing test, the cohort was divided into two subgroups. Patients with parameters I/E and CV RR under 10th percentile with respect to age and sex were considered to suffer from diabetic autonomic neuropathy. Results: The prevalence of DAN in our cohort with average diabetes duration of 5 years was 41 %. Comparing subgroups with and without DAN, no significant differences were found in diabetes duration, onset, serum glucose, triglycerides, total cholesterol, microalbuminuria. The patients with DAN were significantly leaner (BMI 20,078 vs. 22,099 kg/m2) (p = 0,022). The short-term metabolic compensation of type 1 diabetes (HbA1c, DCCT) was suprisingly better in the subgroup with DAN (9,660 % vs. 11,000 %) (p = 0,04), but the difference was on the border of statistic significance. Conclusion: The prevalence of diabetic autonomic neuropathy in our cohort of adolescents with type 1 diabetes was high regardless of relatively short diabetes duration. In a view of other results, the puberty is independent risk factor for early development of DAN. In order to evaluate metabolic compensation of type 1 diabetes in adolescents, it is better to calculate average value of HbA1c in a recent period.