Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE

Abstract

Microvascular, macrovascular and neurological complications are the key causes of morbidity and mortality among type II diabetes mellitus (T2DM) patients. The aim of this study was to investigate the alterations of cardiac autonomic function of diabetic patients in relation to three types of diabetes-related complications. ECG recordings were collected and analyzed from 169 T2DM patients in supine position who were diagnosed with nephropathy (n = 55), peripheral neuropathy (n = 64) and retinopathy (n = 106) at two hospitals in the UAE. Comparison between combinations of patients with complications and a control diabetic group (CONT) with no complication (n = 34) was performed using time, frequency and multi-lag entropy measures of heart rate variability (HRV). The results show that these measures decreased significantly (p<0.05) depending on the presence and type of diabetic complications. Entropy, (median, 1st- 3rd interquartile range) for the group combining all complications (1.74,1.37–2.09) was significantly lower than the corresponding values for the CONT group (1.77, 1.39–2.24) with lag-1 for sequential beat-to-beat changes. Odds ratios (OR) from the entropy analysis further demonstrated a significantly higher association with the combination of retinopathy and peripheral neuropathy versus CONT (OR: 1.42 at lag 8) and an even OR for the combination of retinopathy and nephropathy (OR: 2.46 at lag 8) compared to the other groups with complications. Also, the OR of low frequency power to high frequency power ratio (LF/HF) showed a higher association with these diabetic-related complications compared to CONT, especially for the patient group combining all complications (OR: 4.92). This study confirms that the type of microvascular or peripheral neuropathy complication present in T2DM patients have different effects on heart rate entropy, implying disorders of multi-organ connectivity are directly associated with autonomic nervous system dysfunction. Clinical practice may benefit from including multi-lag entropy for cardiac rhythm analysis in conjunction with traditional screening methods in patients with diabetic complications to ensure better preventive and treatment outcomes in the Emirati Arab population.

HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients

“…Mohammedi et al [ 45 ] demonstrated that the presence of microvascular (including peripheral neuropathy) or macrovascular disease at baseline is independently associated with an increased risk of major clinical micro- and macrovascular events and death in patients with type 2 diabetes. Khandoker et al [ 46 ] revealed that peripheral neuropathy and other microvascular complications could affect heart rate variability. The previous study and our present results imply that DPN and other diabetic vascular complications are interconnected.…”

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“…This allows looking at the high correlation between independent variables (usually 0.50 and above), as such one of the highly correlated variables was dropped before the Model analysis. The BLR was chosen due to dependent variable was made dichotomous; high REA-ECD acceptance=1 (Khandoker et al, 2017;Copas, 1983;Altman & Andersen, 1989;Derksen & Keselman, 1992;Huguet et al, 2017). BLR choice was also due to independent variables were on different measurements.…”

Relationship between heart rate variability and carotid intima‐media thickness in the Brazilian Longitudinal Study of Adult Health – ELSA‐Brasil

“…Since the autonomic nervous system (ANS) innervates vascular walls, regulating wall contractility and tension, alterations in this control manifest as detrimental effects on endothelial and vascular function, favouring atherogenesis (Chistiakov et al, 2015;Grassi et al, 2015). Impairments in the ANS and vascular function frequently coexist in the pathogenesis of different cardiovascular diseases, such as myocardial infarction (Gautier et al, 2007;Khandoker et al, 2017;Sessa et al, 2018) and stroke (Bots et al, 1996;O'Leary et al, 1999;Kwon et al, 2008), reflecting a complexity relationship. Autonomic activity can be easy and noninvasively assessed through its action on the cardiovascular system, named heart rate variability (HRV) analysis (Task Force of ESC & NASPE, 1996;Ulleryd et al, 2017).…”

“…Impairments in the ANS and vascular function frequently coexist in the pathogenesis of different cardiovascular diseases, such as myocardial infarction (Gautier et al , ; Khandoker et al , ; Sessa et al , ) and stroke (Bots et al , ; O'Leary et al , ; Kwon et al , ), reflecting a complexity relationship. Autonomic activity can be easy and noninvasively assessed through its action on the cardiovascular system, named heart rate variability (HRV) analysis (Task Force of ESC & NASPE, ; Ulleryd et al , ).…”