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Journals / Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi / 2026 / Volume: 12 Issue: 2

Heart Rate Variability and Diastolic Dysfunction in Children with Type 1 Diabetes: A Cross-Sectional Study

Tip 1 Diyabetli Çocuklarda Kalp Hızı Değişkenliği ve Diyastolik Disfonksiyon: Kesitsel Bir Çalışma

Gülay Can Yılmaz(MUĞLA SITKI KOÇMAN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR.)0000-0003-0525-1231
Perran Boran(MARMARA UNIVERSITY, SCHOOL OF MEDICINE)0000-0002-9885-7656
Levent Yılmaz(Muğla İl Sağlık Müdürlüğü)0009-0007-1491-8399
Mehmet Ali Astarcıoglu(KUTAHYA HEALTH SCIENCES UNIVERSITY)0000-0001-8577-9890
Emre Ertürk(LifeMed Tıp Merkezi)0009-0005-1564-0208
Engin Tutar(MARMARA UNIVERSITY, SCHOOL OF MEDICINE)0000-0002-8460-1983
Ayşe Gülnur Tokuç(MARMARA UNIVERSITY, SCHOOL OF MEDICINE)0000-0001-5291-2923
Pages
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Publication Date
2025-08-28
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

In conclusion, this study highlights the potential of heart rate variability parameters as early markers of subclinical myocardial changes in children with type 1 diabetes.

📌 3 Key Takeaways

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Objective & Hypothesis:Reduced heart rate variability (HRV) is an indicator of subclinical cardiac autonomic dysfunction.
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Key Findings & Data:This study aimed to evaluate the relationship between HRV and diastolic dysfunction in children with type 1 diabetes mellitus (T1DM), and to examine the impact of glycemic control and diabetes duration on subclinical cardiovascular changes.
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Conclusion & Impact:In conclusion, this study highlights the potential of heart rate variability parameters as early markers of subclinical myocardial changes in children with type 1 diabetes.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Diastolic Dysfunction · Heart Rate Variability · Cardiac Autonomic Neuropathy

Abstract

Reduced heart rate variability (HRV) is an indicator of subclinical cardiac autonomic dysfunction. This study aimed to evaluate the relationship between HRV and diastolic dysfunction in children with type 1 diabetes mellitus (T1DM), and to examine the impact of glycemic control and diabetes duration on subclinical cardiovascular changes. This cross-sectional study included 57 children with T1DM and 40 age and sex matched healthy controls. HRV was assessed using 24-hour Holter monitoring, and diastolic function was evaluated with Doppler echocardiography. Children with type 1 diabetes had lower heart rate variability indices compared to controls, particularly in those with poor glycemic control. Early diastolic dysfunction was observed in the diabetic group, indicated by higher A-wave velocities (67.0 ± 5.9 cm/s vs. 62.5 ± 7.4 cm/s, p=0.004), prolonged deceleration time (181.3 ± 42.5 ms vs. 143.3 ± 25.1 ms, p<0.001), and increased isovolumic relaxation time (52.6 ± 9.8 ms vs. 44.4 ± 10.2 ms, p<0.001). Chronic high blood glucose levels and longer diabetes duration were strongly associated with both reduced heart rate variability and diastolic abnormalities. In conclusion, this study highlights the potential of heart rate variability parameters as early markers of subclinical myocardial changes in children with type 1 diabetes. Early detection and targeted interventions based on these parameters may may contribute to reducing long-term cardiovascular risks in this population.

Özet

Azalmış kalp hızı değişkenliği (KHD), subklinik kardiyak otonomik disfonksiyonun bir göstergesidir. Bu çalışma, tip 1 diyabetli çocuklarda KHD ile diyastolik disfonksiyon arasındaki ilişkiyi değerlendirmeyi ve glisemik kontrol ile diyabet süresinin subklinik kardiyovasküler değişiklikler üzerindeki etkisini incelemeyi amaçlamıştır. Kesitsel tasarıma sahip bu çalışmaya, tip 1 diyabetli 57 çocuk ile yaş ve cinsiyet açısından eşleştirilmiş 40 sağlıklı kontrol dahil edilmiştir. KHD, 24 saatlik Holter monitörizasyonu ile; diyastolik fonksiyon ise Doppler ekokardiyografi kullanılarak değerlendirilmiştir. Tip 1 diyabetli çocuklarda, özellikle glisemik kontrolü kötü olanlarda, kalp hızı değişkenliği indeksleri kontrol grubuna kıyasla daha düşük bulunmuştur. Diyabetik grupta, A dalgası hızının yüksek olması (67.0 ± 5.9 cm/s vs. 62.5 ± 7.4 cm/s , p=0.004), deselerasyon zamanının uzaması (181.3 ± 42.5 ms vs. 143.3 ± 25.1 ms, p<0.001) ve izovolümetrik gevşeme süresinin artması (52.6 ± 9.8 ms vs. 44.4 ± 10.2 ms, p<0.001) ile karakterize erken diyastolik disfonksiyon saptanmıştır. Kronik yüksek kan şekeri düzeyleri ve uzun diyabet süresi, hem azalmış kalp hızı değişkenliği hem de diyastolik anormalliklerle güçlü bir şekilde ilişkili bulunmuştur. Sonuç olarak, bu çalışma, kalp hızı değişkenliği parametrelerinin tip 1 diyabetli çocuklarda subklinik miyokardiyal değişikliklerin erken belirteçleri olabileceğini ortaya koymaktadır. Bu parametrelere dayalı erken tanı ve hedefe yönelik müdahaleler, bu popülasyonda uzun vadeli kardiyovasküler risklerin azaltılmasına katkı sağlayabilir.

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Cite This Article

Yılmaz, G. C., Boran, P., Yılmaz, L., Astarcıoglu, M. A., Ertürk, E., Tutar, E., Tokuç, A. G. (2025). Heart Rate Variability and Diastolic Dysfunction in Children with Type 1 Diabetes: A Cross-Sectional Study. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, Volume: 12 Issue: 2. https://doi.org/10.47572/muskutd.1618223

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References (29)

  1. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1160-74.
  2. Bjornstad P, Dart A, Donaghue KC, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Microvascular and macrovascular complications in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1432-50.
  3. Nathan DM, Cleary PA, Backlund JY, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-53.
  4. Nordwall M, Hyllienmark L, Ludvigsson J. Early diabetic complications in a population of young patients with type 1 diabetes mellitus despite intensive treatment. J Pediatr Endocrinol Metab. 2006;19(1):45-54.
  5. Ifuku M, Takahashi K, Hosono Y, et al. Left atrial dysfunction and stiffness in pediatric and adult patients with Type 1 diabetes mellitus assessed with speckle tracking echocardiography. Pediatr Diabetes. 2021;22(2):303-19.
  6. Rakha S, Aboelenin HM. Left ventricular functions in pediatric patients with ten years or more type 1 diabetes mellitus: Conventional echocardiography, tissue Doppler, and two-dimensional speckle tracking study. Pediatr Diabetes. 2019;20(7):946-54.
  7. Brunvand L, Heier M, Brunborg C et al. Advanced glycation end products in children with type 1 diabetes and early reduced diastolic heart function. BMC Cardiovasc Disord. 2017;17(1):133.
  8. Nadeau KJ, Reusch JE. Cardiovascular function/dysfunction in adolescents with type 1 diabetes. Curr Diab Rep. 2011;11(3):185-92.
  9. Schäfer M, Nadeau KJ, Reusch JEB. Cardiovascular disease in young People with Type 1 Diabetes: Search for Cardiovascular Biomarkers. J Diabetes Complications. 2020;34(10):107651.
  10. Caglar Acar O, Epcacan S, Uner A, et al. Evaluation of left and right ventricular functions using conventional and tissue Doppler echocardiography in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2016;29(8):885-91.
  11. Vazeou A, Papadopoulou A, Miha M, et al. Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Eur J Pediatr. 2008;167(8):877-84.
  12. Chessa M, Butera G, Lanza GA, et al. Role of heart rate variability in the early diagnosis of diabetic autonomic neuropathy in children. Herz. 2002;27(8):785-90.
  13. Özgür S, Ceylan Ö, Şenocak F, et al. An evaluation of heart rate variability and its modifying factors in children with type 1 diabetes. Cardiol Young. 2014;24(5):872-9.
  14. Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. 2010;33(2):434-41.
  15. Gözüküçük D, İleri BA, Başkan SK, et al. Evaluation of cardiac autonomic dysfunctions in children with type 1 diabetes mellitus. BMC Pediatr. 2024;24(1):229.
  16. Akinci A, Celiker A, Baykal E, et al. Heart rate variability in diabetic children: sensitivity of the time- and frequency-domain methods. Pediatr Cardiol. 1993;14(3):140-6.
  17. Castiglioni P, Faini A, Nys A, et al. Heart Rate Variability for the Early Detection of Cardiac Autonomic Dysfunction in Type 1 Diabetes. Front Physiol. 2022;13:937701.
  18. Kardelen F, Akçurin G, Ertuğ H, et al. Heart rate variability and circadian variations in type 1 diabetes mellitus. Pediatr Diabetes. 2006;7(1):45-50.
  19. Demir K, Konakçı E, Özkaya G, et al. New Features for Child Metrics: Further Growth References and Blood Pressure Calculations. J Clin Res Pediatr Endocrinol. 2020;12(2):125-9.
  20. DiMeglio LA, Acerini CL, Codner E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes. 2018;19 Suppl 27:105-14.
  21. Kanjwal K, George A, Figueredo VM, et al. Orthostatic hypotension: definition, diagnosis and management. J Cardiovasc Med (Hagerstown). 2015;16(2):75-81.
  22. Yoldaş T, Örün UA, Sagsak E, et al. Subclinical left ventricular systolic and diastolic dysfunction in type 1 diabetic children and adolescents with good metabolic control. Echocardiography. 2018;35(2):227-33.
  23. Salem M, El Behery S, Adly A, et al. Early predictors of myocardial disease in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes. 2009;10(8):513-21.
  24. Javorka M, Javorková J, Tonhajzerová I, et al. Heart rate variability in young patients with diabetes mellitus and healthy subjects explored by Poincaré and sequence plots. Clin Physiol Funct Imaging. 2005;25(2):119-27.
  25. Boysen A, Lewin MA, Hecker W, et al. Autonomic function testing in children and adolescents with diabetes mellitus. Pediatr Diabetes. 2007;8(5):261-4.
  26. Chen SR, Lee YJ, Chiu HW, et al. Impact of glycemic control, disease duration, and exercise on heart rate variability in children with type 1 diabetes mellitus. J Formos Med Assoc. 2007;106(11):935-42.
  27. Cho YH, Craig ME, Srinivasan S, et al. Heart rate variability in pubertal girls with type 1 diabetes: its relationship with glycemic control, insulin resistance and hyperandrogenism. Clin Endocrinol (Oxf). 2014;80(6):818-24.
  28. El Tantawy A, Anwar G, Esmail R, et al. Cardiac autonomic neuropathy linked to left ventricular dysfunction in type 1 diabetic patients. Cardiovasc Endocrinol Metab. 2022;11(4):e0272.
  29. Karavanaki K, Kazianis G, Konstantopoulos I, et al. Early signs of left ventricular dysfunction in adolescents with type 1 diabetes mellitus: the importance of impaired circadian modulation of blood pressure and heart rate. J Endocrinol Invest. 2008;31(4):289-96.