Key result
Higher LF/HF ratio links to greater LAGE, an association modified by daily movement behaviors.
Why the study?
Heart rate variability reflects autonomic regulation and may influence glycemic control in type 1 diabetes, but whether daily movement behaviors modify this association is unknown.
Do daily movement behaviors modify the association between heart rate variability and glycemic variability in adults with type 1 diabetes?
Observational (n=23)
Do daily movement behaviors modify the association between heart rate variability and glycemic variability in adults with type 1 diabetes?
Effect estimate: estimate 73.82
p-value: p=0.0247
Daily movement behaviors such as sleep and physical activity modify the association between heart rate variability and glycemic variability in adults with type 1 diabetes.
Daily movement behaviors may modify HRV-GV links in T1D; hypothesis-generating and should not yet change practice.
Introduction and Objective: Heart rate variability (HRV) reflects autonomic regulation and may influence short-term glycemic control in type 1 diabetes (T1D). Because HRV is influenced by sleep and physical activity, these behaviors may modify its association with glycemic variability (GV). The objective of this study was to determine whether daily movement behaviors (i.e., sleep and physical activity) modify the association between HRV and GV in adults with T1D. Methods: Daily HRV metrics (SDNN, RMSSD, LF/HF) were derived from Empatica E4 recordings, and glycemic outcomes (SD, CV, MAGE, LAGE, CONGA-60, TIR) were obtained from Dexcom G6 CGM. Sleep was measured with a Zmachine EEG device. Physical activity (sedentary time, LPA, MVPA) was measured with an ActiGraph accelerometer. Linear mixed-effects models with random intercepts tested HRV × behavior interactions, adjusting for demographic and clinical covariates. Statistical significance was set at p < 0.05. Results: A total of 23 adults with T1D were included. Participants had a mean age of 32.63 years, BMI of 28.16 kg/m², HbA1c of 6.52 % and diabetes duration of 6.26 years. Across 84 linear mixed effects models, only one HRV main effect reached significance: a higher LF/HF ratio was associated with greater LAGE (estimate = 73.82, p = 0.0247). SDNN interacted with MVPA for TIR (estimate = −0.00448, p = 0.0064). The LF/HF ratio showed significant interactions with sleep for CONGA60 and LAGE (estimates = 0.0371 and 0.1935) and with LPA for LAGE (estimate = −0.2337, p = 0.0487). RMSSD showed no significant interactions. HbA1c was the most consistent predictor across outcomes, whereas other demographic covariates demonstrated no stable associations. Conclusion: Daily movement behaviors substantially modified the associations between HRV and glycemic variability, indicating that autonomic function influences glucose regulation within specific behavioral contexts. Disclosure P. Chen: None. L. Quinn: None.
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CHEN et al. (2026) conducted an observational in Type 1 diabetes (n=23). Heart rate variability and daily movement behaviors was evaluated on Glycemic variability (LAGE) (estimate 73.82, p=0.0247). Higher LF/HF ratio was associated with greater LAGE (estimate 73.82, p=0.0247), and daily movement behaviors significantly modified the associations between HRV and glycemic variability.
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