Type 2 Diabetes Mellitus Is Independently Associated With Decreased Neural Baroreflex Sensitivity

Abstract

Objective. Impaired baroreflex function is an early indicator of cardiovascular autonomic imbalance. Patients with type 2 diabetes (T2D) have decreased baroreflex sensitivity (BRS), however, whether the neural and/or mechanical component of the BRS (nBRS and mBRS, respectively) is altered in those with high metabolic risk (HMR, impaired fasting glucose and/or metabolic syndrome) or with overt T2D, is unknown. We examined this in a community-based observational study, the Paris Prospective Study III. Approach and Results. In 7626 adults aged 50 to 75 years, resting nBRS (estimated by low frequency gain, from carotid distension rate and RR intervals) and mBRS were measured by high-precision carotid echotracking. The associations between overt T2D or HMR as compared to subjects with normal glucose metabolism (NGM) and nBRS or mBRS were quantified using multivariable linear regression analysis. There were 319 subjects with T2D (61±6 years, 77% male), 1450 subjects with HMR (60±6 years, 72% male) and 5857 subjects with NGM (59±6 years, 57% male). Compared to NGM, nBRS was significantly lower in HMR subjects (β=-0.07, 95% CI-0.12,-0.01, p=0.029), and in subjects with T2D (β=-0.18, 95% CI-0.29,-0.07, p=0.002) after adjustment for confounding and mediating factors. Subgroup analysis suggests significant and independent alteration in mBRS only among HMR patients who had both impaired fasting glucose and metabolic syndrome. Conclusion. In this community-based study of individuals aged 50 to 75, a graded decrease in nBRS was observed in HMR subjects and patients with overt T2D as compared to NGM subjects.

Advanced Cross-Correlation Function Application to Identify Arterial Baroreflex Sensitivity Variations From Healthy to Diabetes Mellitus

“…We speculated that BRS dysfunction in DM and AN could cause a change from phaselead to phase-lag. Furthermore, in line with previous studies, baroreflex response was reduced, and the delay was prolonged (Javorka et al, 2011;Xiao et al, 2019;Cseh et al, 2020), which supported the assumption. Therefore, we proposed an advanced cross-correlation function to estimate BRS in healthy and DM groups.…”

“…A previous study reviewed approaches to measure baroreflex sensitivity (BRS), using the sequence method, cross-correlation method, cross-spectral method, synchronization index, cross multiscale entropy, joint symbolic dynamics, similarity index, etc., in DM. The study revealed that DM has baroreflex impairment with reduced baroreflex response and prolonged baroreflex (Javorka et al, 2011;Xiao et al, 2019;Cseh et al, 2020). Abnormal baroreflex function could indicate autonomic cardiovascular imbalance early (Ziegler et al, 2018;Cseh et al, 2020).…”

“…The study revealed that DM has baroreflex impairment with reduced baroreflex response and prolonged baroreflex (Javorka et al, 2011;Xiao et al, 2019;Cseh et al, 2020). Abnormal baroreflex function could indicate autonomic cardiovascular imbalance early (Ziegler et al, 2018;Cseh et al, 2020). Present BRS analysis methods based on HR and BP analysis might not be able to observe the sympathetic baroreflex component by its nature (Persson et al, 2001;Swenne, 2013;Kawada et al, 2021).…”

Neurovascular Dysregulation During Exercise in Type 2 Diabetes

“…Whether T2D impairs arterial and cardiopulmonary baroreflex function during exercise has not been directly tested (Figure 2). Several studies indicate that T2D attenuates cardiac baroreflex sensitivity at rest (Holwerda et al, 2016b;Cseh et al, 2020;Kuck et al, 2020). However, this may not be specific to T2D, as weight-matched controls also exhibit impaired cardiac baroreflex control at rest compared to lean controls suggesting that obesity rather than T2D impairs arterial baroreflex control of HR (Holwerda et al, 2016b).…”

High Fasting Glycemia Predicts Impairment of Cardiac Autonomic Control in Adults With Type 2 Diabetes: A Case-Control Study

“…Most T2D also have high blood glucose, which is associated with a higher risk of all-cause mortality, especially due to severe cardiovascular events ( 5 ). In addition, T2D has been associated with deleterious effects on nerve fibers that make up the autonomic nervous system (ANS) ( 6 , 7 ), which might be associated with further health risks.…”