Heart rate variability in type 2 diabetes mellitus: A systematic review and meta–analysis

Abstract

BackgroundCardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta–analysis to evaluate the impact of T2DM on HRV parameters.MethodsThe PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords “diabetes” AND (“heart rate variability” OR “HRV”). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter–electrocardiogram. Measurements of HRV retieved were: RR–intervals (or Normal to Normal intervals—NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations.ResultsWe included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR–intervals (effect size = –0.61; 95%CI –1.21 to –0.01), lower SDNN (–0.65; –0.83 to –0.47), lower RMSSD (–0.92; –1.37 to –0.47), lower pNN50 (–0.46; –0.84 to –0.09), lower total power (–1.52; –2.13 to –0.91), lower LF (–1.08; –1.46 to –0.69]), and lower HF (–0.79; –1.09 to –0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DMConclusionsT2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.

Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation, emotion, and interpersonal processes

“…The importance of influences on resting vmHRV is underscored by evidence of its robust associations with physical health and well-being (Hillebrand et al, 2013;Thayer et al, 2010;Thayer & Lane, 2007), and by its potential role as a mechanism linking personality, emotion and interpersonal processes with subsequent health (Kemp, Koenig, & Thayer, 2017). However, research on associations with physical health must consider the possibility of reverse causality, as reduced resting vmHRV can both contribute to and result from disease (e.g., Benichou et al, 2018).…”

Heart rate variability in patients presenting with neurally mediated syncope in an emergency department

“…spectral power) is followed by progressive functional denervation, which is associated with severe autonomic dysfunction [24]. Both sympathetic and parasympathetic activities were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy [25]. An increase in nightly HR in conjunction with a decrease in parameters of parasympathetic activity suggests that liraglutide, a drug for diabetes, may affect sympathovagal balance [22].…”

Breeze

“…Cardiac functioning can be quantified as high frequency heart rate variability (HF-HRV), i.e., the portion of the beat-to-beat interval between 0.15 and 0.4 Hz [43]. In fact, decreased HF-HRV is linked not only to stress [40], depression [38] or anxiety disorders [13] but also to type-2 diabetes mellitus [7], chronic obstructive pulmonary diseases [60] or hypertension [48]. Moreover, lower values of HF-HRV have been associated with death and disability [75].…”

“…Each subject had to assess these items after each breathing task. Consistent with prior work [8], subjects were asked to rate single-item statements per construct on 7-point Likert scales ranging from strongly disagree (1) to strongly agree (7). Additionally and during the second self-report assessment step, subjects were asked to indicate their preference for either Breeze or the active control condition via binary forced-choice questions regarding the very same constructs (e.g., for perceived ease of use, the item was formulated as follows: Which of the versions of the breathing training was the easiest to follow?).…”

“…Only two significant differences are found: perceived ease of use scores are significantly higher for the circle-based active control condition (p = .004), and perceived enjoyment scores are significantly higher for Breeze (p = .005). [62]; SD = standard deviation; 7-point Likert scales ranging from strongly disagree (0) to strongly agree (7) were used.…”