Comparative study of the early predictive values of the heart rate variability parameters, neurophysiological and metabolic markers for the early detection of type two diabetic visceral autonomic neuropathy

Background: Early detection of diabetic neuropathy is crucial for both health and economic stability. Clinically, timely diagnosis and intervention can prevent the progression to severe complications, significantly preserving a patient's quality of life and mobility. Economically, this proactive approach reduces the long-term burden on healthcare systems. Objective: To assess and compare the early predictive value of different heart rate variability (HRV) parameters for the early detection of type 2 diabetes mellitus (T2DM)-induced neuropathy. And to evaluate their correlation with the novel serum parameters, Brain-Derived Neurotrophic Factor (BDNF), and Nesfatin-1. Results: HRV parameters showed early changes in type 2 diabetics, even before the development of overt neuropathy. We investigated early changes in heart rate variability parameters in a cohort of type 2 diabetic patients compared to age-matched healthy controls. We found that heart rate variability changes occur even before the development of neuropathic symptoms, suggesting that it can be used as an early detection measure in diabetic neuropathy. Also, we measured serum brain-derived neurotrophic factor and Nesfatine-1 in all study subjects and found brain-derived neurotrophic factor to show a stronger correlation with the HRV parameters than Nesfatine-1. This correlation was more significant in the diabetic patients than the healthy controls. Conclusion: We concluded that the HRV metrics can serve as sensitive early biomarkers for detecting type 2 diabetes mellitus-induced neuropathy, especially cardiac autonomic neuropathy, even in T2DM patients without clinical signs of neuropathy. Additionally, BDNF is superior to Nesfatin-1 for early detection of visceral autonomic neuropathy.