Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus

Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus

Author Silva, Ticiana Paes Autor UNIFESP Google Scholar
Rolim, Luiz Clemente Autor UNIFESP Google Scholar
Sallum Filho, Celso Autor UNIFESP Google Scholar
Zimmermann, Livia M. Autor UNIFESP Google Scholar
Malerbi, Fernando Autor UNIFESP Google Scholar
Dib, Sergio Atala Autor UNIFESP Google Scholar
Abstract Background The occurrence of hypoglycemia has been associated with the presence of cardiovascular autonomic neuropathy. Cardiovascular autonomic reflex tests are the gold standard diagnostic method for cardiovascular autonomic neuropathy. Nevertheless, impaired heart rate variability indices on spectral analysis have been reported before cardiovascular autonomic reflex test abnormalities arise. The objective of the present study was to analyse the association between the severity of hypoglycemia and indices of heart rate variability on spectral analysis. Methods Consecutive type 1 diabetes patients were prospectively enrolled. Heart rate variability indices were assessed by spectral analysis. One abnormal test result was used to define impaired spectral analysis. The severity of hypoglycemia was evaluated by a hypoglycemia score and patients were classified into absent/minor or moderate/severe hypoglycemia groups. Results Patients with moderate/severe hypoglycemia were older, had longer duration of diabetes and had higher rates of diabetic complications. After adjusting for baseline clinical characteristics, impaired spectral analysis (OR: 3.85

95% IC 1.23-12.02

p = 0.020), nephropathy (OR: 4.15, 95% IC 1.27 - 13.54

p = 0.018) and macrovascular complications (OR: 12.18, 95% IC 1.14 - 129.84

p = 0.038) remained independent predictors of moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia had lower heart rate variability in the high frequency band of spectral analysis, reflecting a decreased parasympathetic tonus on the heart. These patients also had higher low frequency/high frequency ratios, ultimately denoting the occurrence of cardiovascular autonomic imbalance. Conclusions Impaired heart rate variability on spectral analysis, nephropathy and macrovascular complication were shown to independently predict moderate/severe hypoglycemia. Patients with moderate/severe hypoglycemia showed loss of the cardio protective effect of vagal activity according to spectral analysis. Copyright (C) 2016 John Wiley & Sons, Ltd.
Keywords hypoglycemia
cardiovascular autonomic dysfunction
type 1 diabetes
heart rate variability
xmlui.dri2xhtml.METS-1.0.item-coverage Hoboken
Language English
Date 2017
Published in Diabetes-Metabolism Research And Reviews. Hoboken, v. 33, n. 2, p. -, 2017.
ISSN 1520-7560 (Sherpa/Romeo, impact factor)
Publisher Wiley
Extent -
Access rights Closed access
Type Article
Web of Science ID WOS:000397399600004

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