Heart rate variability in children with type 1 diabetes mellitus

The search of articles was conducted on PubMed, Ibecs, Medline, Cochrane, Lilacs, SciELO and PEDro databases using the MeSH terms: "autonomic nervous system", "diabetes mellitus", "child", "type 1 diabetes mellitus", "sympathetic nervous system" and "parasympathetic nervous system", and their respective versions in Portuguese (DeCS). Articles published from January 2003 to February 2013 that enrolled children with 9-12 years old with type 1 diabetes mellitus were included in the review.

DATA SYNTHESIS:

The electronic search resulted in four articles that approached the heart rate variability in children with type 1 diabetes mellitus, showing that, in general, these children present decreased global heart rate variability and vagal activity. The practice of physical activity promoted benefits for these individuals.

CONCLUSIONS:

Children with type 1 diabetes mellitus present changes on autonomic modulation, indicating the need for early attention to avoid future complications in this group.

diabetes mellitus, type 1; child; autonomic nervous system; heart rate variability

Indexes	Definition	Autonomic component of physiological modulation
SDNN	Standard deviation of all normal R-R intervals recorded at an interval of time, expressed in ms	Sympathetic and parasympathetic
SDANN	Standard deviation of the means of R-R normal intervals, every 5 minutes, for a period of time expressed in ms	Sympathetic and parasympathetic
RMSSD	Root mean square of differences between subsequent normal R-R intervals, in a time interval, expressed in ms	Parasympathetic
PNN50	Percentage of subsequent R-R intervals with difference of duration longer than 50ms	Parasympathetic
ULF	Ultra low frequency component	Sympathetic and parasympathetic
LF	Low frequency component	Sympathetic
HF	High frequency component	Parasympathetic
LF/HF	Ratio between low and high frequency	Sympathetic and parasympathetic

Authors and year of publication	Objectives	Indexes of HRV analyzed	Conclusions
Kardelen et al, 2006⁽¹⁶⁾	To analyze the HRV and the circadian variation in the short and long term, in T1DM	SDNN, SDANN, RMSSD, pNN50, ULF, VLF, LF, HF, LF (nu), HF (nu)* and LF/HF	Decreased global HRV and decreased influence of the circadian rhythm, reflecting a significant reduction of the parasympathetic activity and a possible increase in sympathetic tone
Chen et al, 2007⁽²⁴⁾	To investigate the influence of glycemic control, disease duration, and exercise on autonomic nerve function in children with T1DM	LF, HF and TP**	The Hb1Ac was the most important predictor of HRV in children at rest, compared to the time of the disease. Moreover, the HRV during exercise differed from HRV at rest
Chen et al, 2008⁽²⁵⁾	To analyze the influence of physical activity on the function of the autonomic nervous system, through HRV, in children with T1DM	LF, HF, TP** and LF/HF	Physical activity promotes increased parasympathetic activity of diabetic children
Lucini et al, 2009⁽²⁶⁾	To assess in children and adolescents with T1DM the initial changes in cardiac and vascular autonomic regulation and to verify their progression over time	LF (ms²), LF (nu), HF (ms²), HF (nu) and LF/HF	Children and adolescents with T1DM exhibit baroreflex disorders and increased LF of the systolic blood pressure. The advancement of the disease promotes increase of LF (nu) and decreased HF (ms²)

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