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Association between the severity of nocturnal asymptomatic hypoglycemia and heart rate variability change in patients with type 2 diabetes

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Aim

Current knowledge regarding the changes in cardiac autonomic nerve function during asymptomatic hypoglycemia in type 2 diabetes (T2D) is limited. This study aimed to investigate the association between the severity of nocturnal asymptomatic hypoglycemia and short-term heart rate variability (HRV) changes in patients with T2D.

Methods

Comparison of changes was performed in a short-term time domain and frequency domain analysis of HRV during nocturnal asymptomatic hypoglycemia [interstitial glucose (IG) ≤ 3.5 mmol/L] and during euglycemia in T2D subjects treated with insulin (n = 58). Further stratification was performed according to the degree of hypoglycemia. All patients underwent 72 h of simultaneous Holter and continuous interstitial glucose monitoring (CGM).

Results

Fifty-two nocturnal asymptomatic hypoglycemia episodes were included in the spectral analysis of HRV in the participants. In the hypoglycemic (IG < 3 mmol/L) subjects, the short-term time domain parameters (standard deviation of normal R-R intervals (SDNN), RMSSD (the square root of the mean squared difference of successive RR intervals)) and normalized high-frequency (HF) were significantly lower than those during the matched euglycemic period (IG 5–10 mmol/L) (all p < 0.01), and the normalized low-frequency (LF)/HF ratio was increased (p < 0.05). In the hypoglycemic (≤ 3 IG ≤ 3.5 mmol/L) subjects, although HF was significantly lower than that in the euglycemic subjects (p < 0.01), no differences were observed in the SDNN, RMSSD, or the LF/HF ratio.

Conclusions

The spectral analysis of HRV showed that reduced HRV was associated with the severity of nocturnal asymptomatic hypoglycemia; severe hypoglycemia aggravates the cardiac autonomic nerve imbalance.

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Acknowledgments

The authors appreciate the patients and study investigators who participated in this study.

Funding

This research was supported by the Medical and Health Science and Technology Program of Zhejiang Province, China (2020KY324), and the Shaoxing Bureau of Science and Technology, Zhejiang Province, China (2016CX006).

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Authors and Affiliations

  1. Department of Endocrine and Metabolism, Shaoxing People’s Hospital, 568# Zhongxing North RoadZhejiang Province, Shaoxing, 312000, People’s Republic of China

    Qiao-Ying You & Fu-Yuan Zuge

  2. Yuecheng District, Shaoxing University School of Medicine, 900# Chengnan AvenueZhejiang Province, Shaoxing, 312000, People’s Republic of China

    Bing Xu

Authors
  1. Qiao-Ying You
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  2. Bing Xu
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  3. Fu-Yuan Zuge
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Contributions

All authors reviewed and approved the final version of the manuscript. YQY elaborated the study design, collected the data for the study, and wrote the manuscript. ZGFY collected the data and performed statistical analysis. XB collected the data for the study and critically revised the manuscript.

Corresponding author

Correspondence to Qiao-Ying You.

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The study received local ethics approval, and all subjects provided written informed consent before participation.

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The authors declare no competing interests.

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You, QY., Xu, B. & Zuge, FY. Association between the severity of nocturnal asymptomatic hypoglycemia and heart rate variability change in patients with type 2 diabetes. Int J Diabetes Dev Ctries 43, 719–724 (2023). https://doi.org/10.1007/s13410-022-01151-7

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  • DOI: https://doi.org/10.1007/s13410-022-01151-7

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