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Aims To characterize autonomic nervous system function by means ofthe heart rate and blood pressure responses to various stimuli in relationto pubertal maturation in patients with Type 1 diabetes mellitus (DM). Methods One hundred out of 138 eligible patients at the Out-patient Diabetes Clinicand 100 healthy control subjects were examined in terms of cardiovascularparameters at rest, during deep breathing and when standing. Heartrate variabil-ity was analysed with time domain,frequency domain and fractal dimension parameters. Tanner pubertalstaging was performed before the examinations. Results The time domain parameters of heart rate variability at restor during standing did not significantly differ between the patientsand controls in total or at pubertal stages. In the spectral analysis ofheart rate variability the very low frequency band was decreasedin the patients during standing (P = 0.023).The increase in the very low frequency (P = 0.013)and low frequency (P = 0.031) spectralpowers upon changing from a supine position to standing was attenuatedin the patients in total, while no significant differences wereobserved within the Tanner pubertal stages between patients and controls.Heart rate variability during deep breathing was decreased in the patientswith distal polyneuropathy (P = 0.006). Conclusions Although cardiovascular integrity is in the main well preserved inadolescent patients with Type 1 DM, these patients are prone toattenuated autonomic nervous system reactivity. Diabet. Med. 19, 932–938 (2002)