Effect of hypoglycemia on heart rate variability in people with type 1 diabetes and impaired awareness of hypoglycemia
Open accessAbstract
Background: People with impaired awareness of hypoglycemia (IAH) are at elevated risk of severe, potentially hazardous, hypoglycemia and would benefit from a device alerting to hypoglycemia. Heart rate variability (HRV) changes with hypoglycemia due to sympathetic activity. Since IAH is associated with suppressed sympathetic activity, we investigated whether hypoglycemia elicits a measurable change in HRV in patients with T1D and IAH. Method: Eligible participants underwent a modified hyperinsulinemic euglycemic hypoglycemic clamp (glucose nadir, 43.1 ± 0.90 mg/dl), while HRV was measured by a VitalConnect HealthPatch. Measurements of HRV included Root Mean Square of the Successive Differences (RMSSD) and low to high frequency (LF:HF) ratio. Wilcoxon rank-sum test was used for testing within-subject HRV changes. Results: We included 12 participants (8 female, mean age 57 ± 12 years, mean HbA1c 57 ± 5 mmol/mol (7.4 ± 0.4%)). Symptoms increased from 4.0 (1.5-7.0) at euglycemia to 7.5 (5.0-11.0) during hypoglycemia ( P = .003). In response to hypoglycemia, the LF:HF ratio and RMSSD increased when normalized for data obtained during euglycemia (both P < .01). The LF:HF ratio increased in 6 participants (50%) and declined in one other participant (8%). The RMSSD decreased in 3 (25%) and increased in 4 (33%) participants. In 2 patients, no change in HRV could be detected in response to hypoglycemia. Conclusions: This study reveals that hypoglycemia-induced changes in HRV are retained in the majority of people with T1D and IAH, and that these changes can be detected by a wearable device. Real-time HRV seems usable for detection of hypoglycemia in patients with IAH.
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Hypoglycemia causes changes in physiological parameters.
“Hypoglycemia is a frequent and dangerous complication of diabetes (1), causing changes in physiological parameters (2,3).”
From Noninvasive Hypoglycemia Detection in People With Diabetes Using Smartwatch Data (2023) · cites this paper as [3]
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Noninvasive Hypoglycemia Detection in People With Diabetes Using Smartwatch Data
Lehmann, V., Föll, S., Maritsch, M., van Weenen, E., Kraus, M., Lagger, S., Odermatt, K., Albrecht, C., Fleisch, E., Zueger, T., et al. (2023) · Diabetes Care · doi:10.2337/dc22-2290 · Cited by 47 · see citing works
- Authors
- Koeneman, M., Olde Bekkink, M., Meijel, L. V., Bredie, S., & de Galan, B.
- Affiliations
- Radboud University Medical Center (NL)
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Corresponding author
- Koeneman, Mats
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2021-04-15
- Volume
- 16
- Issue
- 5
- Pages
- 1144-1149
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC9445333
- OpenAlex
- W3156079136
- Cited by
- 11
- References
- 30
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Diabetes Science and Technology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- AstraZeneca
- Diabetes Fonds (2016.30.004)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- impaired awareness of hypoglycemia, type 1 diabetes, hypoglycemia, heart rate variability, sympathetic nervous system, hyperinsulinemic-euglycemic clamp, wearable devices, hypoglycemia detection, LF/HF ratio, RMSSD, autonomic function
- MeSH terms
- Aged, Diabetes Mellitus, Type 1, Female, Heart Rate, Humans, Hypoglycemia, Hypoglycemic Agents, Middle Aged, Glucose Clamp Technique
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