Influence of glycaemic management and BMI on cardiac autonomic markers in children with type 1 diabetes: a prospective cohort study

Sep 30, 2026

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Examine subclinical cardiovascular autonomic neuropathy (CAN) in children with well-regulated type 1 diabetes by measuring baroreceptor sensitivity (BRS), QT variability index (QTVI), and heart rate variability (HRV). At baseline, 45 children with type 1 diabetes and 37 healthy controls were assessed, with longitudinal follow-up for subsets at 2 years. Time in normoglycaemia increased, yet BRS, QTVI, and HRV showed no group differences. Higher BMI z score (≥1) related to increased QTVI and correlations with diabetes duration and glycaemic measures, supporting targeted prevention.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

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Methods

Results

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Introduction

Diabetologia (2025) 69:480–490 [https://doi.org/10.1007/s00125-025-06592-3](https://doi.org/10.1007/s00125-025-06592-3) Influence of glycaemic management and BMI on cardiac autonomic markers in children with type 1 diabetes: a prospective cohort study Ebba Bergdahl1 · Gun Forsander2 · Linda Milkovic3 · Frida Sundberg4 · Frida Dangardt1,5 Received: 16 June 2025 / Accepted: 15 August 2025 / Published online: 11 November 2025 © The Author(s) 2025 Abstract Aims/hypothesis Our aim was to examine the presence of subclinical cardiovascular autonomic neuropathy (CAN) in a cohort of children with well-regulated type 1 diabetes by measuring baroreceptor sensitivity (BRS), QT variability index (QTVI) and heart rate variability (HRV) . Methods Forty-five children (aged 6–15.99 years) with a type 1 diabetes duration of ≥5 years, and 37 healthy control children were included at baseline; and 28 and 18 children, respectively, were included at 2 year follow-up. Cardiac BRS, QTVI and HRV were measured and anthropometrical data and blood samples were collected from all study participants. Longitudinal HbA 1c values from 3 months after type 1 diabetes diagnosis and continuous glucose monitoring data from the children with type 1 diabetes were also collected. Results Time in normoglycaemia (TING) increased significantly from 42% to 48% between baseline and 2 year follow-up (p=0.042) . No difference in BRS, QTVI or HRV were found between the study groups at baseline or follow-up. Children with type 1 diabetes with a BMI z score ≥1 showed higher QTVI compared with either lean children with diabetes or healthy control children. QTVI correlated with type 1 diabetes duration, longitudinal HbA 1c AUC and cystatin C in children with type 1 diabetes at baseline, and with CV at follow-up. (r=−0.447 p=0.004, r=−0.376 p=0.017, r=−323 p=0.048, andr=0.568p=0.01, respectively) . There was also a correlation between the increase in TING between the study visits and BRSat follow-up in children with type 1 diabetes (r=0.524 p=0.031) . Conclusions/interpretation In this well-regulated type 1 diabetes cohort we did not find manifest signs of CAN in children with type 1 diabetes. These are promising findings and should motivate further to keep striving for normoglycaemia in paediatric diabetes care. Children with both type 1 diabetes and overweight seem more susceptible to early development of CAN and might benefit from earlier and more intensive preventive targeting. Keywords Autonomic dysfunction · Cardiac autonomic neuropathy · Children · Paediatrics · Type 1 diabetes * Ebba Bergdahl [ebba.bergdahl@gu.se](ebba.bergdahl@gu.se) 1 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Department of Paediatric Clinical Physiology, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden 4 School of Medical Sciences, Örebro University, Örebro, Sweden 5 Paediatric Heart Centre, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden Abbreviations BMIz BMI z score BRS Baroreceptor sensitivity CAN Cardiovascular autonomic neuropathy CGM Continuous glucose monitoring CRP C-reactive protein DAN Diabetes autonomic neuropathy DBPz Diastolic BP z score HRV Heart rate variability QTVI QT variability index SBPz Systolic BP z score TING Time in normoglycaemia TIR Time in range WBC White blood cell count Introduction Diabetes autonomic neuropathy (DAN) includes disturbances from the urogenital and gastrointestinal organs, the sudomotor function and cardiovascular autonomic neuropathy (CAN), the latter of which is the most studied form [1] . CAN symptoms include tachycardia, orthostatism and exercise intolerance, and CAN

FAQs

What was the study aim regarding autonomic neuropathy in children with type 1 diabetes?

The study aimed to examine whether subclinical cardiovascular autonomic neuropathy (CAN) was present in children with well-regulated type 1 diabetes using BRS, QTVI, and HRV measurements.

How were participants assessed over time?

Forty-five children with type 1 diabetes and 37 healthy controls were assessed at baseline, with follow-up assessments at 2 years for 28 and 18 participants respectively. Anthropometric data and blood samples were collected, and longitudinal HbA1c and continuous glucose monitoring data were used.

What relationship did BMI show with cardiac autonomic markers?

Children with type 1 diabetes who had a BMI z score ≥ 1 showed higher QT variability index (QTVI) than lean children with diabetes and healthy controls, and QTVI correlated with diabetes duration and glycaemic measures.

Sep 30, 2026

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