Assessing heart rate variability in type 1 diabetes mellitus—Psychosocial stress a possible confounder

Abstract

Background Autonomic neuropathy (AN) commonly arises as a long‐term complication in diabetes mellitus and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram recordings. Psychosocial stress also affects HRV and could be one of several confounders for cardiac AN. The present work investigated the impact of psychosocial stress on HRV in individuals with type 1 diabetes mellitus (T1DM) and assessed the use of salivary cortisol as a biomarker for psychosocial stress in this context. Methods A total of 167 individuals 6–60 years old (113 with T1DM and 54 healthy controls) underwent 24‐hr ECG recordings with HRV analysis. Salivary cortisol was sampled thrice during the registration day. Perceived psychosocial stress along with other factors of possible importance for the interpretation of HRV was documented in a diary. Results Heart rate variability (high‐frequency power during sleep) was reduced (p < .05) with older age, longer diabetes duration, higher mean glucose levels, physical inactivity, and perceived psychosocial stress. Salivary cortisol levels in the evening were increased (p < .05) in women in ovulation phase, in individuals with preceding hypoglycemia or with hyperglycemia. The amplitude of salivary cortisol was reduced (p < .05) with the presence of perceived psychosocial stress, but only in adult healthy controls, not in individuals with diabetes. Conclusion Psychosocial stress might be a confounder for reduced HRV when diagnosing cardiac AN in T1DM. Salivary cortisol is, however, not a useful biomarker for psychosocial stress in diabetes since the physiological stress of both hypoglycemia and hyperglycemia seems to overrule the effect of psychosocial stress on cortisol.

Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis

“…Assessment of heart rate variability (HRV) has received attention as a non-invasive subclinical method to assess autonomic regulation in individuals with type 1 diabetes. [1][2][3] Vinik et al 4 showed that chronically reduced HRV is associated with increased risk of arrhythmia, myocardial infarction, sudden cardiac death and cardiac autonomic neuropathy in people with type 1 and type 2 diabetes. Impaired cardiac autonomic modulation is a progressive phenomenon that is associated with hypoglycaemia and overall glycaemic control, however, the mechanisms behind the development of this alteration are not yet fully understood.…”

“…Assessment of heart rate variability (HRV) has received attention as a non‐invasive subclinical method to assess autonomic regulation in individuals with type 1 diabetes 1–3 . Vinik et al 4 showed that chronically reduced HRV is associated with increased risk of arrhythmia, myocardial infarction, sudden cardiac death and cardiac autonomic neuropathy in people with type 1 and type 2 diabetes.…”

The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey

“…Finally, insulin resistance was shown to be associated with lower cardiac output [ 90 ] and cardiovascular suppression [ 91 ] during and after exercise or cardiac autonomic reflex tests. Anxiety [ 92 ] and psychosocial stress [ 93 ] were shown to reduce HRV and induce further parasympathetic suppression in persons with T1D, indicating the need to consider confounding factors in assessing CAN. Gender and race were also found to be associated with autonomic function [ 94 ].…”

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review

“…The many features of the selected studies are shown in Table 1. The participants in the studies selected were type I diabetes mellitus (T1DM) patients [55][56][57][58], T2DM patients [55,[58][59][60][61][62][63][64][65], pregnant women with gestational diabetes mellitus (GDM) [66][67][68], and patients with diabetic retinopathy (DR) [55]. Figure 1 shows the sample characteristics and psychometric or clinical instruments used to analyse the psychological alterations and primary outcomes related to the salivary biomarkers and psychological alterations.…”

“…In total, 14 articles were included who fulfilled the inclusion criteria. Of these, 11 were observational analyses of which 4 were cross-sectional analyses [57,59,64,67] and 7 were longitudinal [55,56,[61][62][63]66,68]. In addition, three were experimental articles.…”