Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus

Silva, Ticiana Paes; Rolim, Luiz Clemente; Filho, Celso Sallum; Zimmermann, Livia M.; Malerbi, Fernando Korn; Dib, Sérgio Atala

doi:10.1002/dmrr.2830

Cited by 24 publications

(17 citation statements)

References 40 publications

(53 reference statements)

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“…We extend previously reported data on HRV responses to hypoglycemia (8)(9)(10) by showing that continuously derived HRV can be monitored by a wearable device in real-life situations. We also show that both patient-specific and situational factors modulate the effect of hypoglycemia on HRV profiles, which expands previous data on the impact of age and diabetes (duration) on HRV in general (11,12).…”

Section: Discussionsupporting

confidence: 74%

Early Detection of Hypoglycemia in Type 1 Diabetes Using Heart Rate Variability Measured by a Wearable Device

et al. 2019

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OBJECTIVEChanges in heart rate variability (HRV) occur at the initiation of hypoglycemia due to sympathetic nervous system activity. We investigated the use of HRV detection by a wearable device as an early alert for hypoglycemia. RESEARCH DESIGN AND METHODSThis proof-of-principle study included 23 patients with type 1 diabetes (14 women, mean age 42 6 11 years). Patients wore a VitalConnect HealthPatch for 5 days. Hypoglycemia was defined as glucose £70 mg/dL (£3.9 mmol/L) by fingerstick measurement. HRV was analyzed in standardized periods before the hypoglycemic event. RESULTSSixty-six hypoglycemic events were recorded. Hypoglycemia caused a typical HRV pattern in 36 (55%) of the hypoglycemic events. Eighteen events (27%) showed an atypical pattern. Ten events were unclassified (15%), and two did not display a change in HRV (3%). CONCLUSIONSHypoglycemia causes early changes in HRV that can be detected by a wearable device. Measuring real-time HRV seems promising for early hypoglycemia detection.People with type 1 diabetes (T1D) are at continuous risk of hypoglycemia (1). Typical symptom generation that allows for timely detection of impending hypoglycemia is critical to avoid severe hypoglycemia. However, patients with impaired awareness of hypoglycemia (IAH) have lost the capacity to sense these typical symptoms and are at sixfold higher risk for severe events (2). Since hypoglycemia stimulates the sympathetic nervous system, measuring heart rate variability (HRV), which reflects the balance between the sympathetic and parasympathetic nervous system (3), could be useful for real-time early detection of hypoglycemia. Wearable devices are now available for continuous heart rate measurement with high accuracy and a sufficient sample rate (4) that allows for real-time HRV monitoring in an outpatient setting. This study explores whether HRV changes detected by a wearable device have the potential for early indication of hypoglycemia in people with T1D.

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Section: Discussionsupporting

confidence: 74%

Early Detection of Hypoglycemia in Type 1 Diabetes Using Heart Rate Variability Measured by a Wearable Device

et al. 2019

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“…Patients with moderate and severe hypoglycemia were older, had a longer duration of diabetes, which correlated with the astonishment of chronic complications. The authors observed a lower HRV in the highfrequency spectral analysis band, and an increase in the LF / HF index [19].…”

Section: Discussionmentioning

confidence: 89%

The Influence of Glycemic Control on Heart Rate Variability and Blood Pressure in Adult Patients with the Type 1 Diabetes

Pertseva

Tyshchenko

Moshenets

2018

Romanian Journal of Diabetes Nutrition and Metabolic Diseases

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Background and aims: to identify heart rate variability (HRV) and blood pressure (BP) in patients with type 1 diabetes depending on the duration of disease and glycemic control.Materials and methods: 43 patients were examined. All patients were divided into 2 groups according to the level of НвА1с: group 1 (n=21) with НвА1с ≤ 7.5% and group 2 (n=22) with НвА1с > of 7.5%. All patients underwent daily monitoring of electrocardiogram Holter and ambulatory BP monitoring within 24 hours in parallel with long term monitoring of blood glucose.Results: Hyppoglycemia is characterized by significant decrease root mean square difference between adjacent RR intervals (RMSSD) (r = −0.531; p = 0.003) and number of consecutive RR intervals, the difference between them is more than 50 ms expressed as a percentage of total number of RR-intervals (pNN50%) (r = the −0.503; p = 0.005) and increase of Low Frequency/High Frequency Ratio (LF/HF) (r = 0552; p = 0.002). Patients with hypoglycemia had significantly higher daily diastolic pressure area index (DPAI24) (p = 0.016), and daily diastolic pressure time index DPTI24 (p = 0.025).Conclusion: our findings demonstrate the need to reduce the frequency of hypoglycemia episodes in patients with T1DM.

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“…Therefore, it is interesting to explore whether the increased hypoglycaemia is more important than GV itself and whether it is independently associated with the outcomes of interest. Hypoglycaemia was found to be associated with lengthening of the QTc interval on ECG 83,84 and reduction of cardiac vagal outflow with diminished HRV [85][86][87] .…”

Section: Non-dipping Blood Pressure: Phenomenon Needing Attention Thmentioning

confidence: 99%

The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: A systematic review

Helleputte

Backer

Lapauw

et al. 2020

Diabetes Metabolism Res

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Rigorous glycaemic control -reflected by low HbA1c goals -is of utmost importance in the prevention and management of complications in patients with type 1 diabetes mellitus (T1DM). However, previous studies suggested that short-term glycaemic variability (GV) is important to consider as well, as excessive glucose fluctuations may have an additional impact on the development of diabetic complications. The potential relationship between GV and the risk for cardiovascular autonomic neuropathy (CAN), a clinical expression of cardiovascular autonomic dysfunction, is of increasing interest. This systematic review aimed to summarize existing evidence concerning the relationship between GV and cardiovascular autonomic dysfunction in T1DM.Electronic database search of Medline (Pubmed), Web of Science and Embase was performed, up to October 2019. There were no limits concerning year of publication. Methodological quality was evaluated with the Newcastle Ottawa Scale for observational studies. Six studies (four cross-sectional and two prospective cohorts) were included. Methodological quality of the studies varied from level C to A2. Two studies examined the association between GV and heart rate variability (HRV) and both found significant negative correlations.Regarding cardiovascular autonomic reflex tests (CARTs), two studies did not while two other studies did find significant associations between GV parameters and CART-scores. However, associations were attenuated after adjusting for covariates such as HbA1c, age and disease duration. In conclusion, this systematic review found some preliminary evidence supporting an association between GV and cardiovascular autonomic dysfunction in T1DM. Hence, uncertainty remains whether high GV can independently contribute to the onset or progression of CAN. The heterogeneity in methodological approach made it difficult to compare different studies. Future studies should therefore use uniformly evaluated CGM-derived parameters of GV, while standardised assessment of HRV, CARTs and other potential cardiac autonomic function parameters is needed for an unambiguous definition of CAN. KEYWORDSType 1 diabetes • Complications • Glycaemic variability • Cardiovascular autonomic dysfunction • Cardiovascular autonomic neuropathy • Cardiovascular reflex tests • Heart rate variability ABBREVIATIONS This article is protected by copyright. All rights reserved. BRS Baroreflex sensitivity CAN Cardiovascular autonomic neuropathy CART Cardiovascular autonomic reflex test CGM Continuous glucose monitoring CONGA Continuous overlap net glycaemic action COV Coefficient of variation DAN Diabetic autonomic neuropathy DCCT Diabetes Control and Complications Trial GV Glycaemic variability HBGI High blood glucose index HRV Heart rate variability LBGI Low blood glucose index MBG Mean blood glucose MAG Mean absolute glucose difference MAGE Mean amplitude of glycaemic excursions MODD Mean of daily differences SDT Total standard deviation of glucose values T1DM Type 1 diabetes mellitus RESEARCH IN CONTEXT BOXWha...

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Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus

Cited by 24 publications

References 40 publications

Early Detection of Hypoglycemia in Type 1 Diabetes Using Heart Rate Variability Measured by a Wearable Device

Early Detection of Hypoglycemia in Type 1 Diabetes Using Heart Rate Variability Measured by a Wearable Device

The Influence of Glycemic Control on Heart Rate Variability and Blood Pressure in Adult Patients with the Type 1 Diabetes

The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: A systematic review

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