{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:30:15Z","timestamp":1784619015642,"version":"3.55.0"},"reference-count":36,"publisher":"American Diabetes Association","issue":"10","license":[{"start":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:00:00Z","timestamp":1661212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Cardiac autonomic neuropathy (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of diabetic retinopathy and early kidney dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESEARCH DESIGN AND METHODS<\/jats:title><jats:p>In this prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and albuminuria at baseline, early CAN was defined as one or more abnormalities in seven heart rate tests derived from a 10-min electrocardiogram. Retinopathy was defined as the presence of one or more microaneurysms, early kidney dysfunction as an albumin excretion rate (AER) &amp;gt;7.5 \u03bcg\/min, and albuminuria as an AER &amp;gt;20 \u03bcg\/min. Multivariable generalized estimating equations were used to examine the association between CAN and retinopathy or early kidney dysfunction. Cox proportional hazards regression analysis was used to assess cumulative risks of incident retinopathy and albuminuria.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>At baseline, the mean age of the sample was 13.6 \u00b1 2.6 years, 52% were male, and mean diabetes duration was 6.1 \u00b1 3.3 years. Over a median follow-up of 3.8 (interquartile range 2.2\u20137.5) years, the complication rate 27% for retinopathy, 16% for early kidney dysfunction, and 3% for albuminuria. The mean study HbA1c was 72.3 \u00b1 16 mmol\/mmol (8.6 \u00b1 1.4%). CAN predicted incident retinopathy (odds ratio 2.0 [95% CI 1.4, 2.9]) and early kidney dysfunction (1.4 [1.0, 2.0]) after adjusting for HbA1c and diabetes duration. CAN also predicted retinopathy (hazard ratio 1.57 [95% CI 1.09, 2.26]) and albuminuria (2.30 [1.05, 5.04]) independently of HbA1c.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>CAN predicted incident retinopathy and kidney dysfunction in adolescents with type 1 diabetes, likely reflecting autonomic microvascular dysregulation contributing to complications. Therefore, screening and interventions to reduce CAN may influence the risk of complications.<\/jats:p><\/jats:sec>","DOI":"10.2337\/dc22-0349","type":"journal-article","created":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T12:07:51Z","timestamp":1661256471000},"page":"2391-2395","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":8,"title":["Cardiac Autonomic Nerve Dysfunction Predicts Incident Retinopathy and Early Kidney Dysfunction in Adolescents With Type 1 Diabetes"],"prefix":"10.2337","volume":"45","author":[{"given":"Vallimayil","family":"Velayutham","sequence":"first","affiliation":[{"name":"1The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"2Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia"},{"name":"3Campbelltown Hospital, Campbelltown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7687-2898","authenticated-orcid":false,"given":"Paul","family":"Benitez-Aguirre","sequence":"additional","affiliation":[{"name":"1The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"2Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6004-576X","authenticated-orcid":false,"given":"Maria","family":"Craig","sequence":"additional","affiliation":[{"name":"1The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia"},{"name":"2Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia"},{"name":"4School of Women\u2019s and Children\u2019s Health, University of New South Wales, Kensington, New South 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