Heart rate variability is associated with interstitial glucose fluctuations in type 2 diabetic women treated with insulin

Heart rate variability (HRV) analysis is a commonly used tool for assessment of autonomic function in diabetic subjects. Nevertheless, the effects of glucose fluctuations on HRV remain to be clarified. In this study we investigated the associations of frequency-domain HRV parameters with current and antecedent interstitial glucose fluctuations in insulin-treated type 2 diabetic women at high cardiovascular risk. Sixty-seven women with type 2 diabetes, from 48 to 78 years of age, including 46 ones with cardiovascular autonomic neuropathy (CAN), underwent simultaneous continuous glucose monitoring (CGM) and Holter recording. Eight glucose variability (GV) indices, including standard deviation, 2-h continuous overlapping net glycemic action (CONGA2), lability index, J-index, mean amplitude of glucose excursions, mean absolute glucose (MAG), low blood glucose index (LBGI) and high blood glucose index (HBGI), were calculated from CGM data. The low frequency (LF) and high frequency (HF) power values were estimated on 5-min intervals at fasting and postprandial daytime periods, at night and during CGM-defined hypoglycemia. The values of LF and HF power declined after meals in diabetic women with normal autonomic function tests. Patients with CAN demonstrated blunted postprandial LF and HF reduction and diminished LF/HF ratio during daytime hypoglycemic events. Daytime LF and HF at fasting state correlated negatively with MAG derived from antecedent nocturnal CGM recordings. Positive correlation was found between fasting LF and nocturnal LBGI. The LF power during daytime hypoglycemia demonstrated negative correlations with nocturnal CONGA2, J-index, HBGI and MAG. The nocturnal HBGI and CONGA2, along with HbA1c and daily insulin dose, were predictors of LF during daytime hypoglycemia in multiple regression analysis. Both postprandial and antecedent nocturnal glucose fluctuations affect daytime frequency-domain HRV parameters in insulin-treated type 2 diabetic women. In patients with increased GV the results of short-term assessment of HRV should be interpreted with caution. Fasting state rather than postprandial one seems to be preferable for HRV estimation.