Abstract
Introduction
Diabetic cardiac autonomic neuropathy (CAN) is potentially life threatening and its
severity might further be aggravated by poor glycaemic control. A decrease in Heart
rate variability (HRV) is the earliest finding of CAN even at the sub clinical stage. While intensive glycaemic control prevents the development of CAN in patients with
type 1 diabetes, it is not known whether the intensification of glycaemic control
using insulin would improve cardiovascular autonomic functions in type 2 diabetes
patients. This study aimed to determine the short term effects of optimizing glycaemic
control using insulin on the HRV in type 2 diabetes patients.
Methods
We conducted a single arm open label clinical trial. Participants were poorly controlled
non-insulin treated type 2 diabetes mellitus patients (HbA1c ≥ 7%). The intervention
lasted 60 days and consisted in the intensification of glycaemic control through the
initiation of a basal plus insulin regimen with titration of insulin to protocol defined
glycaemic targets which were; fasting glycaemia: 0.70–1.30 g/L and post prandial glycaemia
<1.80 g/L. Long term HRV measurement was done using a 24-h ambulatory electrocardiographic
(ECG) recording on day 0 and day 60. Wilcoxon signed rank test was used to compare
differences in HRV parameters before and after the intervention.
Results
A total of 29 (14 males and 15 females) consenting type 2 diabetes mellitus patients
without clinical signs of CAN were enrolled and allocated to intervention (14 males
and 15 females). The median age was 52 [43–59] years, and duration of diabetes 3.0
[0.6–6.7] years. The intervention induced a reduction in HbA1c from 10.1 [9.1–11.9]%
to 6.7 [5.9–6.9]% (p < 0.001) without severe hypoglycaemic events. Concerning HRV
parameters, there was a significant improvement in markers of the parasympathetic
tone (PNN50: 5.7 [3.6–10.3]% to 8.1 [3.1–16.9]%, p = 0.008) and sympathetic tone (SDNN:
102.01 [90.45–111.05] ms to 122.40 [91.70–135.95] ms, p = 0.01).
Conclusion
The optimization of glycaemic control using a basal plus insulin regimen while inducing
a significant reduction in glycated hemoglobin, significantly improves 24-h ambulatory
ECG derived sympathetic and parasympathetic activities. This suggests that tight glycaemic
control using insulin may revert cardiac autonomic neuropathy in type 2 diabetes mellitus
patients.
Keywords
Abbreviations:
Bpm (beats per minutes), HbA1c (glycated hemoglobin), HR (heart rate), HRV (heart rate variability), HF (high frequency), LF (low frequency), ms (milliseconds), PNN 50 (percentage of normal to normal intervals differing by more than 50 ms), RMSSD (root-mean-square of successive differences), SDNN (standard deviation of all normal R-R intervals), SDANN (standard deviation of average normal to normal R-R intervals), T2DM (type 2 diabetes mellitus)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 03, 2019
Accepted:
October 1,
2019
Received in revised form:
August 11,
2019
Received:
March 29,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
