Continuous Glucose and Heart Rate Monitoring in Young People with Type 1 Diabetes: An Exploratory Study about Perspectives in Nocturnal Hypoglycemia Detection

Abstract

A combination of information from blood glucose (BG) and heart rate (HR) measurements has been proposed to investigate the HR changes related to nocturnal hypoglycemia (NH) episodes in pediatric subjects with type 1 diabetes (T1D), examining whether they could improve hypoglycemia prediction. We enrolled seventeen children and adolescents with T1D, monitored on average for 194 days. BG was detected by flash glucose monitoring devices, and HR was measured by wrist-worn fitness trackers. For each subject, we compared HR values recorded in the hour before NH episodes (before-hypoglycemia) with HR values recorded during sleep intervals without hypoglycemia (no-hypoglycemia). Furthermore, we investigated the behavior after the end of NH. Nine participants (53%) experienced at least three NH. Among these nine subjects, six (67%) showed a statistically significant difference between the before-hypoglycemia HR distribution and the no-hypoglycemia HR distribution. In all these six cases, the before-hypoglycemia HR median value was higher than the no-hypoglycemia HR median value. In almost all cases, HR values after the end of hypoglycemia remained higher compared to no-hypoglycemia sleep intervals. This exploratory study support that HR modifications occur during NH in T1D subjects. The identification of specific HR patterns can be helpful to improve NH detection and prevent fatal events.

Autonomic cardiac regulation during spontaneous nocturnal hypoglycemia in children with type 1 diabetes

“…So far, HRV during nocturnal hypoglycemia has not been studied in children. However, one recent study reported a change in heart rate before nocturnal hypoglycemia compared to euglycemia 25 …”

“…This is particularly important, as there is evidence, that children with T1D have longer QTc intervals than healthy controls 28–30 . A recent study even found prolonged QTc intervals (>450 ms) in one‐third of children with T1D 25 . A superimposed additional QTc prolonging effect of hypoglycemia could be critical in those children.…”

“…However, one recent study reported a change in heart rate before nocturnal hypoglycemia compared to euglycemia. 25 Strengths of this study are the continuous recording of highquality long-term ECG, the gold standard for HRV analysis combined with glucose monitoring for five consecutive nights. A second strength is the real-life setting of the study.…”

“…[28][29][30] A recent study even found prolonged QTc intervals (>450 ms) in onethird of children with T1D. 25 A superimposed additional QTc prolonging effect of hypoglycemia could be critical in those children.…”

“…However, one recent study reported a change in heart rate before nocturnal hypoglycemia compared to euglycemia. 25 …”