The significance of the effect of glycemic control on heart rate and blood pressure variability in patients with type 1 diabetes
Background. Сardiovascular diseases in diabetes mellitus remain the leading cause of death of these patients. The purpose was to determine changes in heart rate and blood pressure variability in patients with type 1 diabetes mellitus depending on the duration of the disease and the control of glycemia. Materials and methods. We examined 46 patients. The average age of them was 29.40 ± 3.18 years, duration of the disease — 12.50 ± 1.84 years, body mass index — 23.10 ± 0.73 kg/m2. All patients received insulin therapy on a standard bolus scheme, a daily dose of insulin was 45.00 ± 3.76 units. Patients were divided into 2 groups according to the level of glycated hemoglobin (HbA1c): group 1 (n = 20) with HbA1c ≤ 7.5 %, and group 2 (n = 26) with HbA1c > 7.5 %. The groups were divided into subgroups according to the absence (A) or the presence (B) of hypoglycemia. All patients underwent 24-hour Holter ECG monitoring and 24-hour ambulatory blood pressure monitoring in parallel with long-term monitoring of blood glucose. Results. It was found that in patients with type 1 diabetes mellitus, an increase in the disease duration is characterized by a significant decrease in heart rate variability, both hour and frequency indices, namely, a decrease in root mean square of the successive differences, pNN50, and an increase in low frequency/high frequency ratio. The variability of diurnal blood pressure is realized mainly due to an increase in daily diastolic blood pressure. The presence of episodes of hypoglycemia significantly affects both temporal and spectral heart rate variability indices, regardless of HbA1c level. Conclusions. Episodes of hypoglycemia are accompanied by an increase in systolic, diastolic blood pressure and in the heart rate. The incidence of hypoglycemic episodes increases with the duration of type 1 diabetes mellitus, regardless of the HbA1c level.
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International Diabetes Federation. IDF Diabetes Atlas 7th Edition (2015). Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html.
Sarwar KN, Cliff P, Saravanan P, Khunti K, Nirantharakumar K, Narendran P. Comorbidities, complications and mortality in people of South Asian ethnicity with type 1 diabetes compared with other ethnic groups: a systematic review. BMJ Open. 2017 Jul 13;7(7):e015005. PMID: 28710207. doi: 10.1136/bmjopen-2016-015005.
Rawshani A, Rawshani A, Franzén S, et al. Range of Risk Factor Levels: Control, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes Mellitus. Circulation. 2017 Apr 18;135(16):1522-1531. doi: 10.1161/CIRCULATIONAHA.116.025961.
Carricarte Naranjo C, Sanchez-Rodriguez LM, Brown Martínez M, Estévez Báez M, Machado García A. Permutation entropy analysis of heart rate variability for the assessment of cardiovascular autonomic neuropathy intype 1 diabetes mellitus. Comput Biol Med. 2017 Jul 1;86:90-97. doi: 10.1016/j.compbiomed.2017.05.003.
Eckel RH, Hokanson JE. The Prediction of Atherosclerotic Cardiovascular Disease in Type 1 Diabetes Mellitus: Do We Just Stop Here? Circulation. 2016 Mar 15;133(11):1051-3. doi: 10.1161/CIRCULATIONAHA.116.021654.
Galli-Tsinopoulou A, Chatzidimitriou A, Kyrgios I, Rousso I, Varlamis G, Karavanaki K. Children and adolescents with type 1 diabetes mellitus have a sixfold greater risk for prolonged QTc interval. J Pediatr Endocrinol Metab. 2014 Mar;27(3-4):237-43. doi: 10.1515/jpem-2013-0193.
Gruden G, Giunti S, Barutta F, et al. QTc interval prolongation is independently associated with severe hypoglycemic attacks in type 1 diabetes from the EURODIAB IDDM complications study. Diabetes Care. 2012 Jan;35(1):125-7. doi: 10.2337/dc11-1739.
Koivikko ML, Tulppo MP, Kiviniemi AM, et al. Autonomic cardiac regulation during spontaneous nocturnal hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2012 Jul;35(7):1585-90. doi: 10.2337/dc11-2120.
Jaiswal M, Fingerlin TE, Urbina EM, et al. Reduced heart rate variability among youth with type 1 diabetes: the SEARCH CVD study. Diabetes Technol Ther. 2013 Dec;15(12):977-83. doi: 10.1089/dia.2013.0147.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65.
Baumert M, Porta A, Vos MA, et al. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. Europace. 2016 Jun;18(6):925-44. doi: 10.1093/europace/euv405.
Silva AKFD, Christofaro DGD, Bernardo AFB, Vanderlei FM, Vanderlei LCM. Sensitivity, Specificity and Predictive Value of Heart Rate Variability Indices in Type 1 Diabetes Mellitus. Arq Bras Cardiol. 2017;108(3):255-262. doi: 10.5935/abc.20170024.
Limberg JK, Dube S, Kuijpers M, et al. Effect of hypoxia on heart rate variability and baroreflex sensitivity during hypoglycemia in type 1 diabetes mellitus. ClinAuton Res. 2015;25(4):243-50. doi: 10.1007/s10286-015-0301-2.
Silva TP, Rolim LC, Sallum Filho C, Zimmermann LM, Malerbi F, Dib SA. Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus. Diabetes Metab Res Rev. 2017 Feb;33(2). doi: 10.1002/dmrr.2830.
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