What is the clinical evidence from this study?

Study design: Observational. Population: Type 2 diabetes (n=28). Intervention: Change in heart rate (ΔHR). Primary outcome: Correlation between median ΔHR and autonomic symptom score (ASS) (Correlation factor -0.2).

What does this research mean for the field?

Heart rate changes during sensor-detected hypoglycemia correlate poorly with hypoglycemic symptoms in patients with type 2 diabetes, indicating that symptom perception may rely on mechanisms other than the epinephrine-driven adrenergic response. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to assess the relationship between heart rate changes and symptomatic episodes of hypoglycemia in individuals with type 2 diabetes.

June 7, 2026

1038-OR: Poor Correlation between Hypoglycemic Symptoms and Heart Rate Response in Sensor-Detected Hypoglycemia in T2D: Hypo-METRICS Study

Key Result

Heart rate changes during sensor-detected hypoglycemia showed poor correlation with autonomic symptom scores (correlation factor -0.2) in patients with type 2 diabetes.

Key Points

This study aims to assess the relationship between heart rate changes and symptomatic episodes of hypoglycemia in individuals with type 2 diabetes.
Utilized data from the Hypo-METRICS study with 28 participants wearing sensors for 10 weeks.
Recorded hypoglycemia symptoms and heart rate data using specialized applications and FitBit devices.
Analyzed correlations between heart rate changes and various hypoglycemia-related factors.
Identified 41 symptomatic hypoglycemic events with a median heart rate change of 1.59 beats per minute.
Correlations between heart rate changes and autonomic symptom scores were low (e.g., -0.2 for ASS).
Findings suggest that the perception of hypoglycemic symptoms may not be directly related to heart rate changes.

Study Design

Type

Observational (n=28)

Structured PICO

Does change in heart rate correlate with hypoglycemic symptoms during sensor-detected hypoglycemia in patients with type 2 diabetes?

Population

28 participants with type 2 diabetes and intact hypoglycemia awareness who wore blinded continuous glucose monitors for 10 weeks.

Exposure

Blinded continuous glucose monitors and FitBit devices worn for 10 weeks, with real-time recording of hypoglycemia symptoms on a bespoke app.

Outcome

Correlation between change in heart rate (ΔHR) and autonomic/neuroglycopenic symptom scores during symptomatic sensor-detected hypoglycemia (<54mg/dL).surrogate

Heart rate changes during sensor-detected hypoglycemia show poor correlation with symptomatic episodes in type 2 diabetes, suggesting symptom perception may not be solely mediated by epinephrine-driven heart rate changes.

Main Result

Effect estimate: Correlation factor -0.2

Abstract

Introduction and Objective: Hypoglycemia causes an adrenergic response (AR) associated with epinephrine rise. We evaluated if change in heart rate (ΔHR), used as surrogate for AR, can distinguish between symptomatic and asymptomatic sensor-detected hypoglycemia (SDH), and factors affecting this, in type 2 diabetes. We focused on awake, symptomatic SDH54mg/dL from people with intact awareness (Gold≤3), theorizing that any change would be better identified in this group. Methods: We used data from the Hypo-METRICS study. Participants (n=28; median age 62yr (IQR 17), median HbA1c 7.5% (IQR 0.7%), sensor use 39%) wore blinded sensors for 10 weeks and recorded hypoglycemia symptoms and their intensity real-time on a bespoke app. HR data and sleep status were obtained from FitBit devices. We used Spearman’s correlation in R between averaged HR 30min before and after SDH onset, autonomic and neuroglycopenic symptom scores (ASS/NSS), hypoglycemia duration, SDH nadir, rate of glucose change (ΔRoG) before SDH, and SDH rate/week. Results: We identified 41 symptomatic SDH events. Median ΔHR was 1.59 beats per min. Correlation factor between median ΔHR and ASS was -0.2, median ΔHR and NSS 0.08, median ΔHR and ΔRoG -0.23. Low correlation was found among the rest of the variables. Conclusion: HR changes during SDH showed poor correlation with symptomatic episodes, suggesting perception of symptoms may be mediated via other mechanisms from epinephrine. Disclosure V.D. Koutroukas: Other - 1) YDEF-Lilly scholarship to attend EASD, Sep 2024. 2) EASD Robert Turner course, partially funded by Lilly, Apr 2025.; Ended; Lilly. Other - EASD Robert Turner course, partially funded by Lilly, Apr 2025.; Ended; European Association for the Study of Diabetes. Other - travel and accommodation fees for ATTD, Mar 2024; Ended; KelCon GmbH. G. Martine-Edith: None. A. Tziannou: None. J.J. Thomas: None. P. Divilly: Speaker's Bureau; Ended; A. Menarini Diagnostics. Advisory Panel; Ended; Dexcom, Inc. Speaker's Bureau; Ended; Novo Nordisk. P. Choudhary: Advisory Panel; Current; Medtronic. Speaker's Bureau; Current; Medtronic. Research Support; Current; Medtronic. Consultant; Current; Medtronic. Speaker's Bureau; Current; Abbott. Advisory Panel; Current; Abbott. Research Support; Current; Abbott. Speaker's Bureau; Current; Dexcom, Inc. Advisory Panel; Current; Dexcom, Inc. Research Support; Current; Dexcom, Inc. Consultant; Current; Dexcom, Inc. Speaker's Bureau; Current; Insulet Corporation. Advisory Panel; Current; Insulet Corporation. Research Support; Current; Insulet Corporation. Consultant; Current; Insulet Corporation. Speaker's Bureau; Current; Sanofi. Consultant; Current; Sanofi. Speaker's Bureau; Current; Lilly. Advisory Panel; Current; Lilly. Consultant; Current; Lilly. Advisory Panel; Current; Ypsomed AG. Advisory Panel; Ended; Embecta. Speaker's Bureau; Current; Roche Diabetes Care. Research Support; Current; Roche Diabetes Care. Consultant; Current; Roche Diabetes Care. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Glooko, Inc., Cambridge Mechatronics Ltd, vTv Therapeutics. Funding Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement 777460

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