PMID- 29999549
OWN - NLM
STAT- MEDLINE
DCOM- 20190212
LR  - 20190215
IS  - 1464-5491 (Electronic)
IS  - 0742-3071 (Linking)
VI  - 35
IP  - 11
DP  - 2018 Nov
TI  - Cardiovascular autonomic neuropathy and bone metabolism in Type 1 diabetes.
PG  - 1596-1604
LID - 10.1111/dme.13777 [doi]
AB  - AIM: To investigate the association between cardiovascular autonomic neuropathy 
      and bone metabolism in people with Type 1 diabetes. METHODS: We assessed 
      cardiovascular autonomic neuropathy in 329 people with Type 1 diabetes according 
      to heart rate response to deep breathing, to standing and to the Valsalva 
      manoeuvre, and 2-min resting heart rate. More than one pathological non-resting 
      test was defined as cardiovascular autonomic neuropathy. Bone mineral density of 
      the femoral neck (BMDfn) was assessed by dual energy X-ray absorptiometry. Serum 
      parathyroid hormone levels and other bone markers were measured. RESULTS: The 
      mean (sd) age of the participants was 55.6 (9.4) years, 52% were men, and the 
      mean (sd) diabetes duration was 40 (8.9) years, HbA(1c) 62 (9) mmol/mol and 
      estimated GFR 78 (26) ml/min/1.73m(2) . In all, 36% had cardiovascular autonomic 
      neuropathy. Participants with cardiovascular autonomic neuropathy had 4.2% (95% 
      CI -8.0 to -0.2; P=0.038) lower BMDfn and 33.6% (95% CI 14.3 to 53.8; P=0.0002) 
      higher parathyroid hormone levels compared with participants without 
      cardiovascular autonomic neuropathy in adjusted models. Higher resting heart rate 
      remained associated with higher parathyroid hormone level and lower BMDfn after 
      additional adjustment for eGFR (P<0.0001 and P = 0.042, respectively). 
      CONCLUSIONS: The presence of cardiovascular autonomic neuropathy was associated 
      with reduced BMDfn and increased levels of parathyroid hormone. Kidney function 
      may either confound or mediate these findings. Cardiovascular autonomic 
      neuropathy could be associated with increased risk of osteoporosis in Type 1 
      diabetes. Whether cardiovascular autonomic neuropathy directly affects bone 
      metabolism detrimentally or if this association is mediated via decreased kidney 
      function should be investigated further.
CI  - (c) 2018 Diabetes UK.
FAU - Hansen, C S
AU  - Hansen CS
AUID- ORCID: 0000-0002-5782-3476
AD  - Steno Diabetes Centre Copenhagen, Gentofte, Denmark.
FAU - Theilade, S
AU  - Theilade S
AD  - Steno Diabetes Centre Copenhagen, Gentofte, Denmark.
FAU - Lajer, M
AU  - Lajer M
AD  - Steno Diabetes Centre Copenhagen, Gentofte, Denmark.
FAU - Hansen, T W
AU  - Hansen TW
AD  - Steno Diabetes Centre Copenhagen, Gentofte, Denmark.
FAU - Rossing, P
AU  - Rossing P
AD  - Steno Diabetes Centre Copenhagen, Gentofte, Denmark.
AD  - Department of Clinical Medicine, Faculty of Health, Aarhus, Denmark.
AD  - Department of Public Health, Aarhus University, Aarhus, Denmark.
AD  - Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
LA  - eng
GR  - HEALTH-F2-2009-241544/European Community's Seventh Framework 
      programme/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180820
PL  - England
TA  - Diabet Med
JT  - Diabetic medicine : a journal of the British Diabetic Association
JID - 8500858
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Autonomic Nervous System Diseases/complications/*epidemiology
MH  - Bone Density
MH  - Bone and Bones/*metabolism
MH  - Cardiovascular Diseases/complications/*epidemiology
MH  - Case-Control Studies
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus, Type 1/*complications/*epidemiology
MH  - Diabetic Angiopathies/complications/*epidemiology/metabolism
MH  - Diabetic Neuropathies/epidemiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Osteoporosis/*epidemiology/etiology/metabolism
MH  - Risk Factors
MH  - Young Adult
EDAT- 2018/07/13 06:00
MHDA- 2019/02/13 06:00
CRDT- 2018/07/13 06:00
PHST- 2018/07/10 00:00 [accepted]
PHST- 2018/07/13 06:00 [pubmed]
PHST- 2019/02/13 06:00 [medline]
PHST- 2018/07/13 06:00 [entrez]
AID - 10.1111/dme.13777 [doi]
PST - ppublish
SO  - Diabet Med. 2018 Nov;35(11):1596-1604. doi: 10.1111/dme.13777. Epub 2018 Aug 20.