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Adynamic response to cold pain reflects dysautonomia in type 1 diabetes and polyneuropathy

Thomas Arendt Nielsen1,2,3, Søren Lundbye-Christensen1,4, Yoanna Krasimirova Dimitrova3

  • 1Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Scientific Reports
|July 13, 2023
PubMed

Insights

Cardiac autonomic neuropathy (CAN) in type 1 diabetes mellitus (T1DM) patients was assessed using heart rate variability (HRV) during cold pain. T1DM patients showed diminished HRV responses, indicating impaired autonomic function and increased cardiovascular risk.

Area of Science:

  • Cardiology
  • Neurology
  • Endocrinology

Background:

  • Cardiac autonomic neuropathy (CAN) is a common complication of long-term diabetes, often assessed using heart rate variability (HRV).
  • Assessing HRV dynamics during stress, like cold pain, may reveal subclinical CAN in type 1 diabetes mellitus (T1DM).

Purpose of the Study:

  • To investigate if tonic cold pain exposure can unmask CAN in individuals with T1DM by analyzing HRV dynamics.
  • To compare HRV responses to cold pain in T1DM patients with distal symmetrical polyneuropathy versus healthy controls.

Main Methods:

  • Collected 24-hour electrocardiograms (ECG) for HRV analysis in 48 T1DM patients and 21 healthy controls.
  • Utilized ultra-short-term HRV recordings during a 120-second cold pressor test (hand immersion in 2°C water).
  • Analyzed sympathetic and parasympathetic HRV components (e.g., RMSSD, LF) and correlated with QRISK3 scores.

Main Results:

  • T1DM patients exhibited significantly lower overall 24-hour HRV measures compared to controls, confirming dysautonomia.
  • Cold pain exposure in T1DM patients resulted in diminished sympathetic and adynamic parasympathetic HRV responses.
  • T1DM patients showed significantly lower parasympathetic (4% vs. 20%) and sympathetic (11% vs. 73%) HRV responses to cold pain compared to controls.
  • QRISK3 scores negatively correlated with both 24-hour and ultra-short-term HRV measures in T1DM patients.

Conclusions:

  • Tonic cold pain effectively reveals an attenuated sympathovagal response in T1DM patients, characterized by poor parasympathetic and sympathetic adaptability.
  • This impaired neurocardiac regulation in T1DM poses a threat to homeostasis and is associated with an increased risk of cardiovascular disease.
  • The findings highlight the clinical relevance of assessing HRV dynamics during stress for early detection and management of CAN in T1DM.

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