Heart rate changes during sensor-detected hypoglycemia showed poor correlation with autonomic symptom scores (correlation factor -0.2) in patients with type 2 diabetes.
Observational (n=28)
Does change in heart rate correlate with hypoglycemic symptoms during sensor-detected hypoglycemia in patients with type 2 diabetes?
Heart rate changes during sensor-detected hypoglycemia show poor correlation with symptomatic episodes in type 2 diabetes, suggesting symptom perception may not be solely mediated by epinephrine-driven heart rate changes.
Effect estimate: Correlation factor -0.2
Introduction and Objective: Hypoglycemia causes an adrenergic response (AR) associated with epinephrine rise. We evaluated if change in heart rate (ΔHR), used as surrogate for AR, can distinguish between symptomatic and asymptomatic sensor-detected hypoglycemia (SDH), and factors affecting this, in type 2 diabetes. We focused on awake, symptomatic SDH54mg/dL from people with intact awareness (Gold≤3), theorizing that any change would be better identified in this group. Methods: We used data from the Hypo-METRICS study. Participants (n=28; median age 62yr (IQR 17), median HbA1c 7.5% (IQR 0.7%), sensor use 39%) wore blinded sensors for 10 weeks and recorded hypoglycemia symptoms and their intensity real-time on a bespoke app. HR data and sleep status were obtained from FitBit devices. We used Spearman’s correlation in R between averaged HR 30min before and after SDH onset, autonomic and neuroglycopenic symptom scores (ASS/NSS), hypoglycemia duration, SDH nadir, rate of glucose change (ΔRoG) before SDH, and SDH rate/week. Results: We identified 41 symptomatic SDH events. Median ΔHR was 1.59 beats per min. Correlation factor between median ΔHR and ASS was -0.2, median ΔHR and NSS 0.08, median ΔHR and ΔRoG -0.23. Low correlation was found among the rest of the variables. Conclusion: HR changes during SDH showed poor correlation with symptomatic episodes, suggesting perception of symptoms may be mediated via other mechanisms from epinephrine. Disclosure V.D. Koutroukas: Other - 1) YDEF-Lilly scholarship to attend EASD, Sep 2024. 2) EASD Robert Turner course, partially funded by Lilly, Apr 2025.; Ended; Lilly. Other - EASD Robert Turner course, partially funded by Lilly, Apr 2025.; Ended; European Association for the Study of Diabetes. Other - travel and accommodation fees for ATTD, Mar 2024; Ended; KelCon GmbH. G. Martine-Edith: None. A. Tziannou: None. J.J. Thomas: None. P. Divilly: Speaker's Bureau; Ended; A. Menarini Diagnostics. Advisory Panel; Ended; Dexcom, Inc. Speaker's Bureau; Ended; Novo Nordisk. P. Choudhary: Advisory Panel; Current; Medtronic. Speaker's Bureau; Current; Medtronic. Research Support; Current; Medtronic. Consultant; Current; Medtronic. Speaker's Bureau; Current; Abbott. Advisory Panel; Current; Abbott. Research Support; Current; Abbott. Speaker's Bureau; Current; Dexcom, Inc. Advisory Panel; Current; Dexcom, Inc. Research Support; Current; Dexcom, Inc. Consultant; Current; Dexcom, Inc. Speaker's Bureau; Current; Insulet Corporation. Advisory Panel; Current; Insulet Corporation. Research Support; Current; Insulet Corporation. Consultant; Current; Insulet Corporation. Speaker's Bureau; Current; Sanofi. Consultant; Current; Sanofi. Speaker's Bureau; Current; Lilly. Advisory Panel; Current; Lilly. Consultant; Current; Lilly. Advisory Panel; Current; Ypsomed AG. Advisory Panel; Ended; Embecta. Speaker's Bureau; Current; Roche Diabetes Care. Research Support; Current; Roche Diabetes Care. Consultant; Current; Roche Diabetes Care. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Consultant; Current; Glooko, Inc., Cambridge Mechatronics Ltd, vTv Therapeutics. Funding Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement 777460
KOUTROUKAS et al. (2026) conducted an observational in Type 2 diabetes (n=28). Change in heart rate (ΔHR) was evaluated on Correlation between median ΔHR and autonomic symptom score (ASS) (Correlation factor -0.2). Heart rate changes during sensor-detected hypoglycemia showed poor correlation with autonomic symptom scores (correlation factor -0.2) in patients with type 2 diabetes.