Key result
Prediabetes was associated with significantly lower time-domain and frequency-domain indices of heart rate variability compared to healthy controls (P<0.05).
Why the study?
Early detection of cardiac autonomic neuropathy has gained attention due to elevated cardiovascular mortality, with emerging evidence suggesting autonomic neuropathy may predate the stage of prediabetes.
Is prediabetes associated with subclinical cardiac autonomic neuropathy compared to normoglycemic controls?
Case-Control (n=100)
No
Is prediabetes associated with subclinical cardiac autonomic neuropathy compared to normoglycemic controls?
p-value: p=<0.05
Prediabetes is associated with subclinical cardiac autonomic dysfunction as detected by heart rate variability, suggesting that cardiovascular risk may increase prior to the onset of overt diabetes.
May support earlier CAN screening in prediabetes; leaves open need for prospective validation before clinical adoption.
Introduction: Early detection and diagnosis of diabetic autonomic neuropathy, especially cardiac autonomic neuropathy (CAN), have gained attention recently because of their elevated cardiovascular mortality risk. Although the connection between type 2 diabetes mellitus and autonomic neuropathy is well established, evidence is emerging that the association might predate the stage of prediabetes. Objective: The present study was undertaken to compare the prevalence of CAN in prediabetes versus that in normoglycemic controls. Materials and Methods: The study population was selected by purposive sampling from individuals attending a tertiary care hospital from January 2018 to June 2019. Fifty individuals with prediabetes diagnosed by the American Diabetes Association's glycated haemoglobin criteria and 50 age- and gender-matched healthy controls were recruited. CAN was assessed by standard cardiovascular reflex tests, as described by Ewing and Clarke. Changes in R-R with deep breathing, Valsalva manoeuver, and changes in blood pressure (BP) in response to standing and sustained handgrip were evaluated. Three-time domains [standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR intervals (rMSSD) and percentage of successive normal to normal R-R (NN) intervals that differ by more than 50 ms (pNN50)] and four frequency domain indices [very low-frequency band (VLF), low-frequency band (LF), high-frequency band (HF), LF/HF ratio) of heart rate variability (HRV)] were examined. Results: < 0.05). All three-time-domain indices of HRV were significantly lower in persons with prediabetes compared to controls. The peak frequency of LF, peak power of LF, normalised unit of LF, and LF/HF ratio was significantly lower in subjects with prediabetes than in controls. There was no difference in the traditional cardiovascular autonomic reflex testing. Conclusion: Our study demonstrates the presence of subclinical autonomic dysfunction in persons with prediabetes. Early detection of CAN in prediabetes can have future implications for cardiovascular risk reduction.
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Gujjar et al. (2023) conducted a case-control in Prediabetes (n=100). Prediabetes vs. Normoglycemic healthy controls was evaluated on Heart rate variability (HRV) indices and cardiovascular autonomic reflex testing (p=<0.05). Prediabetes was associated with significantly lower time-domain and frequency-domain indices of heart rate variability compared to healthy controls (P<0.05).
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