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Reduced heart rate variability predicts incident diabetic polyneuropathy
Dimitrios Tsilingiris1,2, Daniel Schmalzridt1, Omar Eldesouky1,3
1Department of Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry (Internal Medicine I), University Hospital Heidelberg, Heidelberg, Germany.
Frontiers in Endocrinology
|July 31, 2026
Summary
Cardiovascular autonomic neuropathy (CAN) and reduced heart rate variability (HRV) predict the development of distal symmetrical polyneuropathy (DSPN) in individuals with diabetes mellitus (DM). Reduced HRV is a practical marker for identifying those at elevated risk.
Area of Science:
- Neurology
- Cardiology
- Endocrinology
Background:
- Distal symmetrical polyneuropathy (DSPN) is a common complication of diabetes mellitus (DM).
- Cardiovascular autonomic neuropathy (CAN) and heart rate variability (HRV) are potential early indicators of diabetic complications.
- Predictive markers for DSPN are crucial for early intervention in diabetic patients.
Purpose of the Study:
- To investigate if cardiovascular autonomic neuropathy (CAN) and reduced heart rate variability (HRV) predict the incidence of distal symmetrical polyneuropathy (DSPN) in individuals with diabetes mellitus (DM).
Main Methods:
- 288 individuals with DM underwent baseline assessments for CAN and HRV.
- DSPN was evaluated using three distinct definitions.
- 194 participants without DSPN were followed for an average of 3 years to assess incident DSPN.
Main Results:
- Established CAN independently predicted incident DSPN across all definitions.
- Reduced HRV indices (rMSSD, HF, LF power, CVRR) were associated with increased DSPN risk.
- CAN prevalence was 16.3%, and low HRV indices were observed in 18.6-40.2% of participants at baseline.
Conclusions:
- Established CAN is a significant predictor of future DSPN in individuals with diabetes.
- Reduced HRV serves as a practical and accessible biomarker for identifying individuals at higher risk of developing DSPN.
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