Key result
Prediabetes risk linked to ~8.9-fold higher odds of cardiac autonomic neuropathy.
Why the study?
Data on the relationship between continuous glucose monitoring-derived glycaemic burden and autonomic neural dysfunction in prediabetes and individuals at increased diabetes risk remain limited.
Does short-term glycemic variability or broader metabolic risk status determine early cardiac autonomic neuropathy in individuals at risk for type 2 diabetes?
Cross-Sectional (n=41)
No
Does short-term glycemic variability or broader metabolic risk status determine early cardiac autonomic neuropathy in individuals at risk for type 2 diabetes?
Odds Ratio: 8.89 (95% CI 0.81–97.68)
Absolute Event Rate: 58% vs 11%
p-value: p=0.074
Cardiac autonomic neuropathy is highly prevalent in individuals at risk for type 2 diabetes and appears to be driven by broader metabolic risk factors rather than short-term glycemic variability.
Broader metabolic risk may prompt autonomic neuropathy evaluation in prediabetes; leaves open glycemic variability's independent role pending prospective studies.
Introduction: In prediabetes and in individuals at increased risk of diabetes, data on the relationship between continuous glucose monitoring (CGM)-derived glycaemic burden and autonomic neural dysfunction remain limited. Therefore, the objective of the present study was to investigate whether early neuropathic changes in these populations are related to short-term glycaemic variability or broader metabolic risk. Materials and methods: Increased risk of prediabetes was defined by the Finnish Diabetes Risk Score (HbA1c<5.7% and FINDRISC ≥12 points: n=14; controls <12 points, n=12; and prediabetes by HbA1c 5.70-6.49% (n=15); total number of participants n=41). Associations between metabolic status, CGM-derived metrics and autonomic function (RMSSD, pNN50, E/I ratio) were assessed using univariable and multivariable models. Cardiac autonomic neuropathy (CAN) was analysed by logistic regression, metabolic status by multinomial regression. Results: CAN was present in 16 participants (39%). Age showed a borderline association with autonomic neuropathy (OR = 1.06 per year; p=0.059), which was attenuated after adjustment for metabolic status. Both increased risk of prediabetes and prediabetes groups were significantly associated with older age (RRR = 1.11 and 1.43 per year; p=0.03 and p=0.002, respectively). In regression models, increased prediabetes risk (OR ~8.4) and prediabetes (OR ~7.0) status emerged as potential determinants of CAN independent of age, although confidence intervals were wide. Among CGM-derived metrics, only mean interstitial glucose differed across metabolic groups, while no glycaemic marker was associated with CAN. Conclusion: In this exploratory pilot cohort, CAN appeared to be more closely associated with metabolic risk status than with short-term glycaemic variability. CGM-derived metrics did not predict autonomic or sensory neuropathy, suggesting that early neural impairment in prediabetes and increased diabetes risk may be more closely linked to broader metabolic risk factors beyond short-term glycaemic variability. Larger longitudinal studies are warranted.
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Békeffy et al. (2026) conducted a cross-sectional in Increased risk of type 2 diabetes / Prediabetes (n=41). Increased prediabetes risk status vs. Normal metabolic risk (Control group) was evaluated on Presence of cardiac autonomic neuropathy (CAN) (OR 8.89, 95% CI 0.81-97.68, p=0.074). Increased prediabetes risk was associated with higher odds of cardiac autonomic neuropathy (OR 8.89) compared to controls, whereas short-term glycemic variability metrics were not associated with neural dysfunction.
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