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As glycemic control alone does not prevent complications, we hypothesized that these metabolic disruptions are responsible for the development and progression of diabetic cardiovascular autonomic neuropathy (CAN). We performed standardized cardiovascular autonomic reflex tests and targeted fasting plasma metabolomic analysis of amino acids and TCA cycle intermediates in subjects with type 1 diabetes and healthy control subjects followed for 3 years. Forty-seven participants with type 1 diabetes (60% female and mean \u00b1 SD age 35 \u00b1 13 years, diabetes duration 13 \u00b1 7 years, and HbA1c 7.9 \u00b1 1.2%) had lower fumarate levels and higher threonine, serine, proline, asparagine, aspartic acid, phenylalanine, tyrosine, and histidine levels compared with 10 age-matched healthy control subjects. Higher baseline fumarate levels and lower baseline amino acid levels\u2014asparagine and glutamine\u2014correlate with CAN (lower baseline SD of normal R-R interval [SDNN]). Baseline glutamine and ornithine levels also associated with the progression of CAN (lower SDNN at 3 years) and change in SDNN, respectively, after adjustment for baseline HbA1c, blood glucose, BMI, cholesterol, urine microalbumin-to- creatinine ratio, estimated glomerular filtration rate, and years of diabetes. Therefore, significant changes in the anaplerotic flux into the TCA cycle could be the critical defect underlying CAN progression.<\/jats:p>","DOI":"10.2337\/db19-0145","type":"journal-article","created":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T21:25:11Z","timestamp":1563917111000},"page":"2035-2044","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":66,"title":["Impaired Amino Acid and TCA Metabolism and Cardiovascular Autonomic Neuropathy Progression in Type 1 Diabetes"],"prefix":"10.2337","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7043-4221","authenticated-orcid":false,"given":"Anna V.","family":"Mathew","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamta","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Division of 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