Impact of disease control and co-existing risk factors on heart rate variability in Gujarati type 2 diabetics: An observational study

Abstract

Background:Type 2 diabetes mellitus (T2DM) is a proven threat of cardiac dysautonomia with paucity of studies from India. Poor disease control makes it further worse with co-existence of hypertension in majority. Heart rate variability (HRV) is a validated noninvasive tool to assess cardiac autonomic status.Aim:We studied HRV parameters of type 2 diabetics looking for effects of disease control and other co-existing risk factors.Materials and Methods:Ninety-eight hypertensive and forty normotensive under–treatment, Gujarati type 2 diabetics were evaluated for disease control and risk stratification. Five minutes resting, HRV was measured by Variowin HR, software-based instrument, using standard protocols to record time domain, frequency domain, and Poincare plot HRV parameters. They were compared between subgroups for the difference with P < 0.05 defining statistical significance.Results:All HRV parameters were reduced in type 2 diabetics, having mean age 56 years, mean duration 6 years with poor glycemic but comparatively better pressure control. HRV parameters were significantly not different in good compared to poor glycemics or in subjects with optimum pressure control than those without it. Results did not differ significantly, by the presence of individual cardiovascular risk factor in diabetics except resting heart rate.Conclusion:Our findings of HRV suggest that type 2 diabetics with poor glycemic control do not have a significant difference of cardiac dysautonomia by pressure control, glycemic control, and absence of risk cardiovascular factor. It suggests diabetes as a major cause for cardiac dysautonomia, residual risk despite treatment and need for HRV screening, strict glycemic control, and further studies.

Co-Existence of hypertension worsens post-exercise cardiac autonomic recovery in type 2 diabetes

“…LF/HF ratio denotes sympatho-vagal balance, and an increase signifies sympathetic dominance which could result from either damage to cardiac autonomic nerves by hyperglycemia in T2DM or by the sympathetic overactivity as seen in HTN. Findings of Solanki et al 44 , 45 were in contrast to those of previous studies, where they reported no significant effect of HTN on autonomic function in T2DM. However, they did not include healthy controls or a euglycemic hypertensive group which makes it difficult to compare it with the results of the present study.…”

“…More recently, Istenes et al 14 assessed resting HRV using the frequency domain measures and found an additive effect of HTN on impaired autonomic function in diabetic patients. However, Solanki et al 44 , 45 found non-significant difference in HRV parameters (frequency domain, time domain and non-linear measures) between diabetics with optimal vs. poor BP control. They recorded no difference in the overall HRV except for LF/HF ratio, which was found to be lower in the hypertensive diabetics.…”

Analysis of Complications of Acute Coronary Syndrome and Their Outcomes in India

“…This is followed by breathlessness (28%) and nausea/vomiting (24%) as seen in Gupta, et al study [19,20]. Incidence of nausea and vomiting is reported by Ghanshyam, et al [14] and Solanki [21] which matches with current study.…”

Association of brachial and central hemodynamic parameters to eGFR and proteinuria in Gujarati diabetics with mild-to-moderate nephropathy

“…We found the same scenario in diabetics with than without antihypertensives in our previous studies on various cardiovascular parameters. [32021] 4) We did matching of subgroups by age and gender, and other confounders were also comparable, which was not the case in many other studies, 5) glycemic control was poor in most diabetics alike our previous studies[352021] and that overshadows other risk factors, 6) both BH and CH were measured simultaneously by same device, which is not so in tonometry-based devices,[22] which are used in most studies. 7) It was a cross-sectional design with moderate sample as opposed to vertical studies with large sample.…”