Heart Rate Variability Could Track With Risk for Type 2 Diabetes

Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • Lower autonomic nervous system function — indicated by lower heart rate variability (HRV) on an ECG — was associated with worse beta-cell function (ie, worse response to a glycemic load during an oral glucose tolerance test [OGTT]), in a population-based study of adults in the Netherlands with no diabetes, prediabetes, or type 2 diabetes who participated in the Maastricht Study. 

Why This Matters

  • Until now, no population-based study has investigated beta-cell response to a glycemic load in vivo.

  • The findings suggest that autonomic dysfunction may contribute to beta-cell dysfunction before the onset of type 2 diabetes.

  • Future studies can investigate whether early prevention of autonomic dysfunction — via early modification of risk factors for neurodegeneration (eg, early prevention of hyperglycemia and high alcohol consumption) — may slow the rate of decline of beta-cell function and ultimately help prevent and/or slow the onset of type 2 diabetes.

Study Design

  • Researchers performed a cross-sectional analysis of data from 3451 adults aged 40-75 who participated in the Maastricht Study and completed a baseline survey from November 2010 to September 2013.

  • Heart rate variability was assessed from ECGs recorded using a 12-lead Holter system over 24 hours.

  • After an overnight fast, participants (except those who used insulin or had a fasting plasma glucose > 11.0 mmol/L) underwent a standard 2-hour 75-g OGTT.

  • Researchers calculated an overall beta-cell response composite score from C-peptidogenic index, overall insulin secretion, beta-cell glucose sensitivity, beta-cell potentiation factor, and beta-cell rate sensitivity.

  • They used linear regression analyses with adjustment for potential confounders (demographic, cardiovascular, and lifestyle factors) to study the associations of time- and frequency-domain HRV (composite scores) with beta-cell composite score.

Key Results

  • Participants were a mean age of 60 and 52% were men; 24% had type 2 diabetes.

  • Lower time- and frequency-domain HRV was significantly associated with lower overall beta-cell response composite score (standardized beta, –0.055 and –0.051, respectively) after full adjustment for confounders.

  • These associations were not modified by sex and there was no consistent pattern of interaction by glucose metabolism status.   


  • This was a cross-sectional study, so causal inferences should be made with caution; there may be a bidirectional relationship between autonomic dysfunction and worse beta-cell response to glycemia. 

  • The strength of the associations may be underestimated because the study excluded less healthy individuals who were not eligible for an OGTT.

  • There may be unmeasured confounding.

  • The study included White individuals aged 40-75 years with access to high-quality diabetes care and may not be generalizable to other populations.


  • The study received noncommercial funding as well as unrestricted grants from Janssen-Cilag, Novo Nordisk, Sanofi-Aventis, and Medtronic.

  • The authors declared no competing interests.

This is a summary of a preprint research study, “Lower heart rate variability, an index of worse autonomic function, is associated with worse beta cell response to a glycemic load in vivo — The Maastricht Study,” written by researchers from Maastricht University Medical Centre, the University of Verona, the University of Parma, and the University of Padua, and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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