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Effects of Diabetic and Prediabetic Status on Cardiac Autonomic Function
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Original Research
VOLUME: 1 ISSUE: 3
P: 82-93
December 2023

Effects of Diabetic and Prediabetic Status on Cardiac Autonomic Function

Bull Crdiov Acad 2023;1(3):82-93
DOI: 10.4274/kvbulten.galenos.2024.18209
Eylem Dilara Erkan 1
Saadet Aydın 2
Şebnem Kalay 3
1. Ufuk Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Ankara, Türkiye
2. Bakırçay Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
3. Güven Çayyolu Cerrahi Tıp Merkezi, İç Hastalıkları Kliniği, Ankara, Türkiye
No information available.
No information available
Received Date: 25.12.2023
Accepted Date: 08.01.2024
Publish Date: 16.01.2024
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ABSTRACT

Objective:

It’s known that prolonged high blood glucose levels during the course of diabetes mellitus (DM) lead to the development of autonomic neuropathy. In this study, we investigated the relationship between heart rate variability (HRV) and blood glycemic levels in patients clinically diagnosed with diabetes, in patients without any glucometabolic disorder, and in prediabetic patients.

Material and Methods:

In this study, 100 patients followed in Cardiology and General Internal Medicine outpatient clinics were evaluated retrospectively. Our study includes 3 different groups: 34 patients without any glucometabolic disorders, 35 patients followed up for prediabetes, and 31 patients diagnosed with diabetes. For the analysis of HRV parameters, standard deviation of normal RR intervals in 24 h (SDNN), SDNN index, root mean square of successive RR interval differences (rMSSD) and percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), high frequency (HF), low frequency (LF) and LF/HF parameters were used.

Results:

As a result of post-hoc analyses for HRV parameters, SDNN, SDNN-index and rMSSD values were significantly lower in the diabetes group compared to the control group; very low frequency (VLF) value was found to be lower in the diabetes group compared to the other two groups. No-statistical difference was found between the groups for pNN50, HF, LF and LF/HF, but in the diabetes and pre-diabetes groups, pNN50, HF and LF were numerically lower than in the control group. Looking at the correlation between HRV parameters and FBS by group, a weak negative correlation was found between all variables except LF/HF. A weak to moderate negative correlation with HbA1c was found for SDNN, SDNN-index, rMSSD and VLF. When comparing HRV parameters by treatment type in diabetic patients, no statistically significant difference was found between patients using oral antidiabetic and those using insulin. When HRV parameters were compared by treatment status in the prediabetes group, there was no statistically significant difference between those receiving treatment and those not receiving treatment.

Conclusions:

We think that HRV parameters may be guiding in the diagnosis of cardiac-autonomic-neuropathy in patients with DM and blood glucose levels that have not yet reached pathological levels.

Keywords:
Blood glycaemic status, prediabetes, diabetes, heart rate variability, cardiac autonomic function

References

1
American Diabetes Assosiation. Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36:67-74.
2
Diabetes Mellitus Çalışma ve Eğitim Grubu. Diabetes Mellitus ve Komplikasyonları Tanı,Tedavi ve İzlem Kılavuzu 14 Baskı, TEDM yayınları, 2020.
3
DeFronzo RA. International Textbook of Diabetes Mellitus. 3rd ed. Chichester, West Sussex; Hoboken, NJ: John Wiley 2004.
4
Peer N, Balakrishna Y, Durao S. Screening for type 2 diabetes mellitus. Cochrane Database Syst Rev 2020;5(5):CD005266.
5
Bernardi L, Ricordi L, Lazzari P, Soldá P, Calciati A, Ferrari MR, et al. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circulation 1992;86(5):1443-1452.
6
Kleinman JC, Donahue RP, Harris MI, Finucane FF, Madans JH, Brock DB. Mortality among diabetics in a national sample. Am J Epidemiol 1988;128(2):389-401.
7
Adler AI, Stevens RJ, Neil A, Stratton IM, Boulton AJ, Holman RR. UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care 2002;25(5):894-899.
8
Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28(2):169-180.
9
Satman İ. TURDEP-II’nin Düşündükleri: Türkiye’de Diyabetin Toplumsal ve Ekonomik Yükü. İstanbul Pelikan Tıp & Teknik Kitapçılık 2018.
10
Kayıkçıoğlu M, Payzın S. Kalp hızı değişkenliği. Türk Kardiyoloji Derneği Arş 2001;29:238-245.
11
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996;93(5):1043-1065.
12
Kataoka M, Ito C, Sasaki H, Yamane K, Kohno N. Low heart rate variability is a risk factor for sudden cardiac death in type 2 diabetes. Diabetes Res Clin Pract 2004;64(1):51-58.
13
Malpas SC, Maling TJ. Heart-rate variability and cardiac autonomic function in diabetes. Diabetes 1990;39(10):1177-1181.
14
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996;93(5):1043-1065.
15
Sajadieh A, Rasmussen V, Hein HO, Hansen JF. Familial predisposition to premature heart attack and reduced heart rate variability. Am J Cardiol 2003;92(2):234-236.
16
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982;285(6346):916-918.
17
Güngör M, Başpınar O. Tip 1 Diabetes Mellituslu Çocuk Ve Adölesanlarda Kalp Hızı Değikenliğinin Değerlendirilmesi. Acta Med Nicomedia 2020;3:70-73.
18
Balcıoğlu AS, Akıncı S, Çiçek D, Çoner A, Bal UA, Müderrisoğlu İH. Cardiac autonomic nervous dysfunction detected by both heart rate variability and heart rate turbulence in prediabetic patients with isolated impaired fasting glucose. Anatol J Cardiol 2016;16(10):762-769.
19
Özgür S, Doğan V, Ceylan Ö, Karademir S, Aycan Z, Şenocak F. OP-037 Heart Rate Variability in Patients with Type 1 Diabetes Mellitus. American Journal of Cardiology 2014;113(7):S17.
20
Yıldırım SE. Bozulmuş açlık glukozu, bozulmuş glukoz toleransı ve tip 2 diyabetes mellitus tanısı olan kişilerde kalp hızı değişkenliği ve kalp hızı toparlanma zamanının glukometabolik anormalliği bulunmayan kişilerle karşılaştırılması. Uzmanlık Tezi 2011.
21
Jayachandra S, Kodidala SR. A study of heart rate variability in diabetic mellitus patients. Int Jour of Endoc 2022;18:153-156.
22
Stoickov V, Ilic S, Ilic MD, Nikolic A Mitic V. Impact of diabetes on heart rate variability and left ventricular function in patients after myocardial infarction. Medicine and Biology 2005;12:130-134.
23
Subbalakshmi NK, Adhikari P, Poornima V, Rao KN S. Correlates of SDNN heart rate variability in healthy subjects and subjects with type 2 diabetes mellitus. International Journal of Biomedical and Advance Research 2015;6:208-211.
24
Im SI, Kim SJ, Bae SH, Kim BJ, Heo JH, Kwon SK, et al. Real-time heart rate variability according to ambulatory glucose profile in patients with diabetes mellitus. Front Cardiovasc Med 2023;10:1249709.
25
Singh JP, Larson MG, O’Donnell CJ, Wilson PF, Tsuji H, Lloyd-Jones DM, et al. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study). Am J Cardiol 2000;86(3):309-312.
26
Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, et al. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018;13(4):e0195166.
27
Valensi P, Extramiana F, Lange C, Cailleau M, Haggui A, Maison Blanche P, et al. Influence of blood glucose on heart rate and cardiac autonomic function. The DESIR study. Diabet Med 2011;28(4):440-449.
28
Laura P, Mihai P, Anca C, Iulia D, Dan Lucian D. Heart rate variability and cardiovascular symptoms in patients with diabetes mellitus. Clujul Medical 2010;83:636-640.
29
Migliaro ER, Contreras P. Heart rate variability: short-term studies are as useful as holter to differentiate diabetic patients from healthy subjects. Ann Noninvasive Electrocardiol 2003;8(4):313-320.
30
Galicka-Latała D, Surdacki A, Konduracka E, Kozek E, Latała H. Zmienność rytmu serca u chorych z cukrzyca typu 1 z retinopatia cukrzycowa. Cześć I. Analiza czestotliwościowa [Heart rate variability in type 1 diabetic patients with retinopathy. Part I. Frequency analysis]. Przegl Lek 2010;67(12):1253-1257.
31
Pertseva NO, OV Gurzhiy, KI Moshenets. “Dependence of heart rate variability on indicators of type 1 diabetes mellitus control.” Medicni perspektivi 2020;25(1):88-95.
32
Mural R, Brid N, Prabhuswamimath P, Kuppast V. Comparatıve study of heart rate variability parameters with type 2 diabetes mellitus with healty individuals. Int J Acad Med Pharm 2022;4(4):502-506.