What is the clinical evidence from this study?

Study design: Observational. Population: Diabetes (n=51). Intervention: Decreased CVRR at rest vs. Normal CVRR at rest. Primary outcome: One-leg standing time < 60 seconds (p=0.022).

What does this research mean for the field?

Decreased coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing in non-elderly diabetic inpatients is associated with lower BMI, skeletal mass index, knee strength, and impaired standing balance, with resting CVRR showing stronger links to autonomic and sensory dysfunction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the associations of decreased age-adjusted coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing with autonomic nerve function and physical parameters in non-elderly individuals with diabetes.

October 16, 2023Journal of Diabetes InvestigationOpen Access

Associations of age‐adjusted coefficient of variation of R‐R intervals with autonomic and peripheral nerve function in non‐elderly persons with diabetes

Q: What are the key findings of this study?

Decreased CVRR at rest was significantly associated with a higher proportion of impaired standing balance (66.7% vs 23.8%) and longer voiding times in non-elderly inpatients with diabetes.

Q: What does this research mean for the field?

Decreased coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing in non-elderly diabetic inpatients is associated with lower BMI, skeletal mass index, knee strength, and impaired standing balance, with resting CVRR showing stronger links to autonomic and sensory dysfunction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the associations of decreased age-adjusted coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing with autonomic nerve function and physical parameters in non-elderly individuals with diabetes.

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Key result

Decreased resting CVRR is linked to nearly threefold higher rates of impaired balance in diabetes.

P=0.022
n=51

Why the study?

Early diagnosis of diabetes-associated cardiac autonomic neuropathy using the coefficient of variation of R-R intervals (CVRR) may improve outcomes for individuals with diabetes, but its associations with other autonomic parameters required investigation.

Is decreased age-adjusted CVRR associated with worse autonomic and peripheral nerve function in non-elderly patients with diabetes?

Key Points

To evaluate the associations of decreased age-adjusted coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing with autonomic nerve function and physical parameters in non-elderly individuals with diabetes.
Retrospective analysis of electronic medical records from 51 inpatients with diabetes aged 22–65 years (selected from 141 records after applying exclusion criteria) admitted between March 2015 and March 2019.
All patients were assessed for peripheral and autonomic nerve function, bedside orthostatic parameters, clinical characteristics, and physical abilities.
Decreased CVRR occurred in 9 inpatients (17.6%) at rest and 12 inpatients (23.5%) during deep breathing; both groups demonstrated significantly lower BMI (rest: 21.2 vs 25.1 kg/m², P=0.025; DB: 21.6 vs 25.3 kg/m², P=0.022) and lower SMI (rest: 6.4 vs 7.6 kg/m², P=0.012; DB: 6.6 vs 7.6 kg/m², P=0.024).
Decreased CVRR at rest was significantly associated with a greater absolute fall in diastolic blood pressure from supine to standing (P=0.006) and a higher supine heart rate (P=0.023).
Patients with decreased CVRR at rest and during deep breathing had a significantly longer duration of known diabetes (rest: 18 vs 2 years, P=0.008; DB: 12 vs 2 years, P<0.001) and higher rates of diabetic retinopathy (rest: P=0.014; DB: P=0.001).

Study Design

Type

Observational (n=51)

Multicenter

Structured PICO

Is decreased age-adjusted CVRR associated with worse autonomic and peripheral nerve function in non-elderly patients with diabetes?

Population

51 non-elderly inpatients (aged 22-65 years) with diabetes and HbA1c ≥ 7.0%, free from conditions affecting autonomic nerve function, assessed retrospectively.

Exposure

Decreased age-adjusted coefficient of variation of R-R intervals (CVRR) at rest and during deep breathing

Comparator

Normal age-adjusted CVRR at rest and during deep breathing

Outcome

Associations with autonomic nerve function parameters including orthostatic blood pressure drop, resting heart rate, QTc interval, lower urinary tract dysfunction, and sensory symptomssurrogate

Main Result

Absolute Event Rate: 66.7% vs 23.8%

p-value: p=0.022

Decreased age-adjusted CVRR at rest is a useful indicator of broader autonomic and peripheral nerve dysfunction, including orthostatic hypotension and QTc prolongation, in non-elderly patients with diabetes.

Limitations

Small sample size with a small proportion of decreased CVRR
Potential confounding variables
High proportion of missing data for diabetes duration

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May flag broader neuropathy affecting balance and voiding; leaves open prospective validation before clinical use in non-elderly diabetes.

Cite This Study

Sugimoto et al. (2023) conducted an observational in Diabetes (n=51). Decreased CVRR at rest vs. Normal CVRR at rest was evaluated on One-leg standing time < 60 seconds (p=0.022). Decreased CVRR at rest was significantly associated with a higher proportion of impaired standing balance (66.7% vs 23.8%) and longer voiding times in non-elderly inpatients with diabetes.

synapsesocial.com/papers/6a1d56451c2cbcb15c5e2667 https://doi.org/10.1111/jdi.14094

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Implication

May flag broader neuropathy affecting balance and voiding; leaves open prospective validation before clinical use in non-elderly diabetes.