Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis

Q: What are the key findings of this study?

Rapid increases in glucose (>0.6 mmol/L per 5 min) during OGTT significantly reduced RMSSD (33±17 vs 38±15 ms, P=0.002) and pNN50% (P<0.001) while increasing heart rate (P<0.001) in type 1 diabetes.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Type 1 diabetes (n=17). Intervention: Rapid increase in sensor glucose (>0.6 mmol/L within 5 minutes) during 75 g oral glucose tolerance test vs. Stable sensor glucose (<0.3 mmol/L change within 5 minutes) and glucose decreases during OGTT. Primary outcome: Heart rate variability measured by RMSSD (square root of the mean standard difference of successive R-R intervals) across rates of glucose change (p=0.002).

Q: What does this research mean for the field?

Rapid increases in glucose reduce heart rate variability and increase heart rate in adults with type 1 diabetes, whereas static glycemic ranges do not affect heart rate variability. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Max L. Eckstein; Othmar Moser; Norbert J. Tripolt; Peter N. Pferschy; Anna A. M. Obermayer; Harald Kojzar; Alexander Mueller; Farah Abbas; Caren Sourij; Harald Sourij

doi:10.1111/dom.14287

December 7, 2020Diabetes Obesity and MetabolismOpen Access

Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis

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Key result

Rapid glucose rises link to ~5-ms lower RMSSD and reduced HRV in type 1 diabetes.

P=0.002
n=17

Why the study?

The study sought to investigate differences in heart rate variability during oral glucose tolerance tests in response to the rate of glucose change and different glycaemic ranges in individuals with type 1 diabetes.

Does the rate of change in glucose or different glycaemic ranges during an oral glucose tolerance test affect heart rate variability in adults with type 1 diabetes?

Key Points

To investigate differences in heart rate variability during oral glucose tolerance tests in response to the rate of change in glucose and to different glycaemic ranges in adults with type 1 diabetes.
Single-centre, prospective secondary outcome analysis of 17 adults with type 1 diabetes (HbA1c 53 ± 6.3 mmol/L) registered under DRKS00016148.
Participants underwent two 4-hour oral glucose tolerance tests (after 12 and 36 hours of fasting) with continuous glucose monitoring and Holter electrocardiography.
Rate of change in glucose significantly altered heart rate (P < 0.001), RMSSD (P = 0.002), pNN50% (P < 0.001), and QTc (P = 0.04), with heart rate increasing to 76 ± 10 bpm and RMSSD falling to 33 ± 17 ms during rapid glucose rises (>0.6 mmol/L within 5 min).
Glycaemic ranges during the oral glucose tolerance tests did not significantly alter heart rate variability parameters, including heart rate (P = 0.15), SDNN (P = 0.37), RMSSD (P = 0.18), and pNN50% (P = 0.10).

Study Design

Type

Observational (n=17)

Multicenter

No

Structured PICO

Does the rate of change in glucose or different glycaemic ranges during an oral glucose tolerance test affect heart rate variability in adults with type 1 diabetes?

P

Population

17 adults with type 1 diabetes (mean age 37 years, 29.4% female, HbA1c 53 mmol/L, free of neuropathy) undergoing two 4-hour oral glucose tolerance tests after 12 and 36 hours of fasting.

E

Exposure

Two 4-hour oral glucose tolerance tests (75 g glucose in 300 mL water with regular individual bolus insulin dose of 6 ± 2 IU) after 12 and 36 hours of fasting, evaluated across rates of glucose change (specifically rapid glucose increase >0.6 mmol/L within 5 minutes [I2]) and glycaemic ranges.

C

Comparator

Within-subject comparison across different rates of sensor glucose change (decreases D2 [>10 mg/dL per 5 min], D1 [0.3-0.6 mmol/L per 5 min], stable glucose N [<0.3 mmol/L per 5 min], increase I1 [0.3-0.6 mmol/L per 5 min]) and across glycaemic ranges (hypoglycaemia 3.0-3.8 mmol/L, euglycaemia 3.9-10.0 mmol/L, hyperglycaemia >10.0-13.9 mmol/L and >13.9 mmol/L).

O

Outcome

Secondary outcome analysis of heart rate variability (HRV) parameters in the time domain (heart rate, SDNN, RMSSD, pNN50%) and frequency domain (LF/HF, total power) and QTc interval measured via 1-channel Holter ECG during 4-hour OGTTs.surrogate

Main Result

Absolute Event Rate: 33% vs 38%

p-value: p=0.002

In adults with type 1 diabetes without neuropathy, acute reductions in heart rate variability are driven by rapid increases in interstitial glucose rather than absolute glycaemic ranges.

Limitations

Clinical setting could have influenced autonomic tone
Limited sample size (n=17)
Inability to merge glycaemic ranges and rates of glucose change due to small sample size and study set-up
Inability to compare both fasting periods (12-hour vs 36-hour) individually across glycaemic ranges and rates of glucose change
Limited sample size (17 participants analysed)
Unable to merge glycaemic ranges and rates of glucose changes due to limited sample size and study set-up
Unable to compare the 12-hour and 36-hour fasting periods individually according to glycaemic ranges and rates of glucose change

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Implication

Hypothesis-generating for rate-dependent glucose effects on HRV in type 1 diabetes; prospective studies needed before clinical consideration.

Abstract

To investigate differences in heart rate variability (HRV) during oral glucose tolerance tests (OGTTs) in response to the rate of change in glucose and to different glycaemic ranges in individuals with type 1 diabetes. This was a single-centre, prospective, secondary outcome analysis in 17 individuals with type 1 diabetes (glycated haemoglobin 53 ± 6.3 mmol/L), who underwent two OGTTs (after 12 and 36 hours of fasting) investigating differences in HRV in response to rapid glucose increases/decreases and different glycaemic ranges during OGTT. Based on the rate of change in glucose level, the variables heart rate (P < 0.001), square root of the mean standard difference of successive R-R intervals (P = 0.002), percentage of pairs of R-R intervals with >50 ms difference (P < 0.001) and corrected QT interval (P = 0.04) were significantly altered, with HRV particularly reduced during episodes of rapid glucose rises. Glycaemic ranges during OGTT had no impact on HRV (P < 0.05). Individuals with type 1 diabetes showed no changes in HRV in response to different glycaemic ranges. HRV was dependent on the rate of change in glucose, especially rapid increases in glucose level.

Discussion

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Cite This Study

Eckstein et al. (2020) conducted an observational in Type 1 diabetes (n=17). Rapid increase in sensor glucose (>0.6 mmol/L within 5 minutes) during 75 g oral glucose tolerance test vs. Stable sensor glucose (<0.3 mmol/L change within 5 minutes) and glucose decreases during OGTT was evaluated on Heart rate variability measured by RMSSD (square root of the mean standard difference of successive R-R intervals) across rates of glucose change (p=0.002). Rapid increases in glucose (>0.6 mmol/L per 5 min) during OGTT significantly reduced RMSSD (33±17 vs 38±15 ms, P=0.002) and pNN50% (P<0.001) while increasing heart rate (P<0.001) in type 1 diabetes.

synapsesocial.com/papers/6a8456847b4d6f59a47c0698 https://doi.org/10.1111/dom.14287

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Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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