European Journal of Pediatrics

, Volume 177, Issue 6, pp 805–813 | Cite as

Cardiac autonomic function in children with type 1 diabetes

  • Kotb Abbass Metwalley
  • Sherifa Ahmed Hamed
  • Hekma Saad Farghaly
Original Article


Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D). This study aimed to evaluate cardiac autonomic nervous system (ANS) function in children with T1D and its relation to different demographic, clinical and laboratory variable. This cross-sectional study included 60 children with T1D (mean age = 15.1 ± 3.3 years; duration of diabetes = 7.95 ± 3.83 years). The following 8 non-invasive autonomic testing were used for evaluation: heart rate at rest and in response to active standing (30:15 ratio), deep breathing and Valsalva maneuver (indicating parasympathetic function); blood pressure response to standing (orthostatic hypotension or OH), sustained handgrip and cold; and heart rate response to standing or positional orthostatic tachycardia syndrome or POTs (indicating sympathetic function). None had clinically manifest CAN. Compared to healthy children (5%), 36.67% of children with T1D had ≥ 2 abnormal tests (i.e., CAN) (P = 0.0001) which included significantly abnormal heart rate response to standing (POTs) (P = 0.052), active standing (30:15 ratio) (P = 0.0001) and Valsalva maneuver (P = 0.0001), indicating parasympathetic autonomic dysfunction, and blood pressure response to cold (P = 0.01), indicating sympathetic autonomic dysfunction. 54.55, 27.27 and 18.18% had early, definite and severe dysfunction of ANS. All patients had sensorimotor peripheral neuropathy. The longer duration of diabetes (> 5 years), presence of diabetic complications and worse glycemic control were significantly associated with CAN.

Conclusions: The study concluded that both parasympathetic and sympathetic autonomic dysfunctions are common in children with T1D particularly with longer duration of diabetes and presence of microvascular complications.

What is Known:

• Cardiovascular autonomic neuropathy (CAN) is a major complication of type 1 diabetes (T1D).

Limited studies evaluated CAN in children with T1D.

What is New:

CAN is common in children with T1D.

Cardiac autonomic functions should be assessed in children with T1D particularly in presence of microvascular complications.


Autonomic neuropathy  Type 1 diabetes mellitus Cardiac function Peripheral neuropathy Glycemic control 



Autonomic nervous system


Cardiac autonomic neuropathy


Heart rate variability


Diabetic autonomic neuropathy


Diastolic blood pressure


Orthostatic hypotension


Positional orthostatic tachycardia syndrome


Root mean square of successive differences


Systolic blood pressure


The percentage of differences between adjacent normal RR intervals > 50 ms


Type 1 diabetes


Authors’ Contributions

KAM participated in the design of the protocol of the study, coordination of the research, performance of the clinical part, analyses of the data, and writing the draft of the paper. SAH participated in the design of the protocol of the study, participated in the analyses of the data and writing the draft of the paper. HSF participated in the design of the protocol of the study, coordination of the research, performance of the clinical part and writing the draft of the paper. All the authors read and approved the manuscript.

Compliance with ethical standard

Conflict of interest

All authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Ethical approval

The study protocol was approved by the Ethics Committee of Faculty of Medicine, Assiut Children University Hospital, Assiut, Egypt.

Informed consent

Written informed consents were obtained from the parents of all participants.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kotb Abbass Metwalley
    • 1
  • Sherifa Ahmed Hamed
    • 2
  • Hekma Saad Farghaly
    • 1
  1. 1.Department of Pediatrics, Faculty of MedicineAssiut UniversityAssiutEgypt
  2. 2.Department of Neurology and Psychiatry, Faculty of MedicineAssiut UniversityAssiutEgypt

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