Autonomic neuropathy - a complication less pronounced in patients with Type 1 diabetes mellitus who have lower blood glucose levels

Aims Autonomic neuropathy is a serious diabetic complication, probably cont ributing to the death of many young people with Type 1 diabetes mellitus. I t is often not diagnosed. Methods Patients with Type 1 diabetes from the Stockholm Diabetes Intervent ion Study were investigated with power spectral analysis (n = 88), heart ra te and blood pressure reactions to tilting (n = 66), and heart rate variabi lity during deep breathing (n = 70) a mean of 11.4 years after randomizatio n to intensified conventional treatment (ICT) or standard treatment (ST), t he treatment groups similar with regard to age, duration of diabetes and me tabolic control at baseline (HbA(1c) 9.4 (1.3)%, mean (SD)). Blood glucose levels (mean of 29 HbA(1c) values) during the 10 years were lower in the pa tients from the ICT group (7.2 (0.6) vs. 8.3 (1.0)%, P = 0.001). Results Heart rare variability (HRV) in the high frequency range (P = 0.034 ), the expiration-inspiration ratio (P = 0.020), and the brake index during tilt (P = 0.044) were lower in the ST group, indicating more pronounced pa rasympathetic insufficiency. Systolic blood pressure fell by 10 (16) mmHg i n the ST group, and by 2.5 (15) mmHg in the ICT group 8 min after rising fr om the supine to a 70 degrees upright position (P = 0.034). A decreased aut onomic function was associated with age and higher HbA(1c). Conclusion Better autonomic nerve function is associated with lower HbA(1c) and lower age which were both the same in the intesively and the conventio nally treatment groups at baseline. After a mean of 11.4 years autonomic fu nction was better in the intensively treated group.