Dysglycaemia and Autonomic Dysfunction: The Diabetes Prevention Program Outcomes Study

Limited data on the link between various measures of glycemia and metabolism and autonomic dysfunction exist. We assessed the association of fasting plasma glucose [FPG], glycated haemoglobin [HbA_1C], fasting insulin, and HOMA-IR and cardiac autonomic function measures separately for men and women in the Diabetes Prevention Program Outcomes Study (DPPOS).

We included DPPOS participants with ECG-based heart rate variability (HRV) measured at the 10-year examination. Resting heart rate (HR), standard deviation of all normal-to-normal intervals (SDNN), and root mean square of successive differences between normal-to-normal intervals (rMSSD) were measured. Multivariable linear regression models assessed the cross-sectional associations of FPG, HbA_1C, and fasting insulin and HOMA-IR with cardiac autonomic function measures.

Among 2266 participants (mean age 65 years, 68.2% women, 53.4% White, 43.7% with prediabetes and 56.3% with diabetes at the time of evaluation), HbA_1C, FPG, fasting insulin and HOMA IR were positively associated with high resting HR in men and women. HbA_1C and FPG were inversely associated with rMSSD (β [95% CI] per SD: -0.08 [-0.14, -0.03] and -0.08 [-0.13, -0.03]) and SDNN (-0.08 [-0.12, -0.03] and -0.07 [-0.11, -0.02]) among women, but not in men. Fasting insulin was inversely associated with rMSSD in the men (-0.09 [-0.18, 0.00]). HOMA-IR was inversely associated with rMSSD in men (-0.11 [-0.20, -0.02] and women -0.07 [-0.12, -0.02]). HOMA-IR was associated with SDNN only in women (-0.05 [-0.10, 0.00]).

Markers of dysglycaemia are associated with worse ECG-based autonomic dysfunction in adults with prediabetes and diabetes in the DPPOS, more so for some glycaemic markers and in women.