Premium
Diabetic autonomic neuropathy in children: immediate heart‐rate response to standing
Author(s) -
MITCHELL E. A.,
WEALTHALL S. R.,
ELLIOTT R. B.
Publication year - 1983
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.1983.tb02087.x
Subject(s) - medicine , heart rate , diabetes mellitus , cardiology , confidence interval , blood pressure , endocrinology
. The immediate heart‐rate response to standing was used to investigate possible autonomic neuropathy in a group of 38 insulin‐dependent diabetic patients in the paediatric age group. The controls and most of the diabetics showed the characteristic response to standing of a rapid increase in heart‐rate and a fall to the resting rate within 15 seconds. Some diabetics showed a flat response or a prolonged gradual increase of heart‐rate on standing. The usual method of describing the change in heart rate that occurs in response to standing is to compare the R‐R intervals at the 30th and 15th beats (30:15 ratio). This is considered less appropriate in children because of the wider variability in heart rate due to sinus arrhythmia. An alternative ratio, the “maximum R‐R/minimum R‐R ratio'’is proposed. This ratio is calculated by dividing the length of the maximum R‐R interval (which occurred after the minimum R‐R interval during the 30 second recording) by the length of the minimum R‐R interval. Compared to 38 index‐selected age and sex matched controls, the diabetics showed a significantly lower mean “maximum R‐R/minimum R‐R ratio (P = 0.033). Six of the diabetics had results lower than the lowest control result. This test gives a prevalence rate of changes suggestive of diabetic autonomic neuropathy of approximately 15% in this age group.