Diagnostic performance of SD-ΔRR during physical stressors for identifying diabetic sensorimotor polyneuropathy

This study aimed to evaluate the clinical efficacy of SD-ΔRR as a novel methodology for short-duration heart rate variability (HRV) assessment for the diagnosis of diabetic sensorimotor polyneuropathy (DSPN) in patients with diabetes.

Participants were assigned into normal fasting glucose (NFG) and diabetes groups. Patients with diabetes were further classified as patients with and without DSPN. Electrocardiograms were recorded at rest, during standing, and during deep breathing to evaluate HRV parameters. HRV was statistically compared between the groups.

A total of 103 patients with diabetes (18 with DSPN, 85 without) and 52 with NFG were included in the analysis. SD-ΔRR values were comparable between the diabetes and NFG groups. However, among patients with diabetes, patients with DSPN had significantly lower SD-ΔRRs than patients without DSPN (P < 0.05). Despite being age- and sex-matched, patients with DSPN had a significantly higher prevalence of hypertension and advanced chronic kidney disease than those without DSPN. Logistic regression analysis demonstrated that SD-ΔRRs during standing and deep breathing were significantly associated with the presence of DSPN in patients with diabetes (P < 0.05 each). After adjustment for confounding factors, only SD-ΔRR during standing remained statistically significant. The cutoff value for SD-ΔRR during standing showed high sensitivity (83%), whereas that during deep breathing demonstrated high specificity (84%) for diagnosis of DSPN.

SD-ΔRR may serve as a clinically informative parameter for identifying DSPN in patients with diabetes. In combination with physical stressors, this metric offers distinct diagnostic advantages with high sensitivity and specificity.