Are Changes in Heart Rate Variability During Hypoglycemia Confounded by the Presence of Cardiovascular Autonomic Neuropathy in Patients with Diabetes?

被引:13
作者
Cichosz, Simon Lebech [1 ,2 ,3 ]
Frystyk, Jan [1 ,2 ]
Tarnow, Lise [4 ,5 ]
Fleischer, Jesper [1 ,2 ]
机构
[1] Aarhus Univ, Aarhus Univ Hosp, Dept Endocrinol & Internal Med, Norrebrogade 44,Bldg 3, DK-8000 Aarhus C, Denmark
[2] Aarhus Univ, Med Res Lab, Inst Clin Res, Norrebrogade 44,Bldg 3, DK-8000 Aarhus C, Denmark
[3] Aalborg Univ, Dept Hlth Sci & Technol, Aalborg, Denmark
[4] Aarhus Univ, Dept Clin Epidemiol, Steno Diabet Ctr, Hillerod, Denmark
[5] Nordsjaellands Hosp Hilleroed, Hillerod, Denmark
关键词
Continuous glucose monitoring; Heart rate variability; Hypoglycemia; Diabetes; Prediction; ASSOCIATION; FREQUENCY; SLEEP;
D O I
10.1089/dia.2016.0342
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: We have recently shown how the combination of information from continuous glucose monitor (CGM) and heart rate variability (HRV) measurements can be used to construct an algorithm for prediction of hypoglycemia in both bedbound and active patients with type 1 diabetes (T1D). Questions remain on how cardiovascular autonomic neuropathy (CAN) influences these measurable changes. This study aims to examine if changes in HRV during hypoglycemia are confounded by the presence of CAN. Methods: Twenty-one adults (hereof 13 men) with T1D prone to hypoglycemia were recruited and monitored with CGM and a Holter device while they performed normal daily activities. CAN was diagnosed using two cardiac reflex tests: (1) deep breathing and (2) orthostatic hypotension and end organ symptoms. Early CAN was defined as the presence of one abnormal reflex test and severe CAN was defined as two abnormal tests or one abnormal test combined with symptoms of autonomic neuropathy. Results: A total of 19 hypoglycemic and corresponding euglycemia periods were identified among the 21 patients. Eleven patients were diagnosed with CAN, hereof five with severe CAN. The HRV parameter low frequency (LF) was significantly (P = 0.029) reduced during hypoglycemia. Changes in LF during hypoglycemia were not different between patients with and without CAN, -0.64 versus -0.48 log(LF) (P = 0.74). Conclusions: Our data show that there are measurable changes in HRV during hypoglycemia, and present in both patients with and without CAN.
引用
收藏
页码:91 / 95
页数:5
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