Postural hypotension in type 1 diabetes: The influence of glycemic control and duration of illness

Abstract

Background: Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub‑saharan Africa where suboptimal care of DM is prevalent.
Aims: The aim of the study was to determine the prevalence of PH in young patients with type 1DM and its relationship with the duration of DM and glycemic control.
Settings and Design: It was a cross‑sectional, case control study carried out in the pediatric out‑patient clinic.
Materials and Methods: Each study participant had blood pressure (BP) measured in the supine and standing positions. Glycated hemoglobin (HbA1c) levels were determined and disease duration was documented. Statistical Analysis: The mean BP in the different positions was determined. The occurrence of PH, duration of disease and HbA1c levels was determined with logistic regression analysis.
Results: A total of 26 diabetic subjects and 26 age and sex matched controls were studied. 12 (46.2%) diabetic subjects had evidence of PH while none of the controls had PH. Diabetic subjects with PH had significantly longer duration of DM than those diabetics without PH (6.79 ± 4.81 vs. 2.83 ± 2.36, P = 0.023). The mean HbA1c level was similar in both groups of diabetic subjects (9.79 ± 2.07 vs. 9.17 ± 2.35). On logistic regression, age, duration of disease, HbA1c level and body mass index were not significant predictors of PH.
Conclusion: PH is common in young persons with type 1 DM, with higher frequency in those with long standing disease.

Key words: Diabetes mellitus, duration, glycemic control, postural hypotension