Abstract: TH-PO928
Hypoxia in Individuals with Type 1 Diabetes and Macroalbuminuria Is Associated with Autonomic Dysfunction
Session Information
- Diabetic Kidney Disease: Biomarkers, Pathogenesis
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Laursen, Jens christian, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Clemmensen, Kim K. b., Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Hansen, Christian Stevns, Steno Diabetes Center, Gentofte, Denmark
- Díaz, Lars J., Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Groop, Per-Henrik, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Frimodt-Moller, Marie, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Bernardi, Luciano, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background
Blood oxygen saturation (SpO2) in the supine position is lower in individuals with type 1 diabetes (T1D) compared to healthy controls (CON). This has been suggested to be linked with cardiovascular autonomic dysfunction (CAD). Presence of CAD in individuals with T1D and diabetic nephropathy is associated with cardiovascular mortality. Our aims were to investigate SpO2 levels in individuals with T1D and different albuminuria-stages compared to CON and to explore associations between SpO2 and baroreflex sensitivity (BRS), a sensitive measure of CAD.
Methods
One-hundred-and-five individuals with T1D and normoalbuminuria (NORMO) and 24 individuals with T1D and macroalbuminuria (MACRO) were compared to 55 CON. SpO2 was measured with pulse oximetry first for one minute in the supine position and then for five minutes in the standing position. A linear mixed-effects model was fitted with SpO2 as outcome and albuminuria-status as exposure, adjusted for sex, age and smoking, with a random person effect. Association between SpO2 and BRS was tested with linear regression analysis and adjusted for albuminuria-status, sex, age and smoking.
Results
In CON, NORMO and MACRO respectively, mean (SD) age was 42.7 (12.6), 43.9 (11.1) and 58.6 (11.0) years; HbA1c was 33.2 (2.4), 63.9 (12.0) and 63.1 (11.7) mmol/mol; BRS was 15.2 (9.5), 13.8 (10.6) and 4.9 (3.2) ms/mmHg; plasma/serum creatinine was 78.3 (12.6), 67.6 (11.5) and 117.1 (53.1) µmol/L; and baseline SpO2 was 97.5 (1.4), 97.0 (1.4) and 96.2 (1.9) %. From supine to standing position, SpO2 increased in CON and NORMO, but not in MACRO. Overall, in mixed effects model mean difference in SpO2 between NORMO and CON was -0.7% (p=0.03) and mean difference in SpO2 between MACRO and CON was -1.4% (p<0.001). In all participants together, SpO2 was positively correlated with BRS (p=0.03).
Conclusion
Individuals with T1D and normoalbuminuria had lower SpO2 than healthy controls and the macroalbuminuria-group had even lower SpO2. SpO2 was positively correlated with BRS. Microvascular damage in lungs of individuals with macroalbuminuria may lead to hypoxia contributing to autonomic dysfunction. It remains to be investigated if low SpO2 contributes to excess cardiovascular mortality in individuals with T1D and diabetic nephropathy.
Funding
- Private Foundation Support