Early detection of hypoglycemia in type 1 diabetes using heart rate variability measured by a wearable device
Abstract
OBJECTIVE: Changes in heart rate variability (HRV) occur at the initiation of hypoglycemia due to sympathetic nervous system activity. We investigated the use of HRV detection by a wearable device as an early alert for hypoglycemia. RESEARCH DESIGN AND METHODS: This proof-of-principle study included 23 patients with type 1 diabetes (14 women, mean age 42 ± 11 years). Patients wore a VitalConnect HealthPatch for 5 days. Hypoglycemia was defined as glucose ≤70 mg/dL (≤3.9 mmol/L) by fingerstick measurement. HRV was analyzed in standardized periods before the hypoglycemic event. RESULTS: Sixty-six hypoglycemic events were recorded. Hypoglycemia caused a typical HRV pattern in 36 (55%) of the hypoglycemic events. Eighteen events (27%) showed an atypical pattern. Ten events were unclassified (15%), and two did not display a change in HRV (3%). CONCLUSIONS: Hypoglycemia causes early changes in HRV that can be detected by a wearable device. Measuring real-time HRV seems promising for early hypoglycemia detection.
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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 [2]
Prior work was generated from small cohorts (the largest cohort of 70 individuals), raising questions of the generalizability of their findings.
“Second, prior work was generated from small cohorts (the largest cohort of 70 individuals), that raise questions of the generalizability of their findings5,22–32.”
From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [24]
Prior work typically uses less than a day of input.
“First, where prior work typically uses less than a day of input5,22–32, we assess the impact of longitudinal input windows ranging up to multiple weeks and demonstrate improved sensitivity with longer windows (AUROC increases by 0.15 from 1-night to 21-night models, in balanced and imbalanced cohorts).”
From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [24]
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Li, K., Cardoso, C., Moctezuma-Ramirez, A., Elgalad, A., & Perin, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20247146 · Cited by 160 · see citing works
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
Towards Wearable-based Hypoglycemia Detection and Warning in Diabetes
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- Authors
- Olde Bekkink, M., Koeneman, M., de Galan, B. E., & Bredie, S. J.
- Affiliations
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud University Medical Center (NL)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-03-11
- Volume
- 42
- Issue
- 4
- Pages
- 689-692
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2922249064
- Cited by
- 58
- References
- 14
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 12 · 2022: 7 · 2021: 8 · 2020: 9 · 2019: 1
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Dutch Diabetes Research Foundation (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
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- hypoglycemia, type 1 diabetes, heart rate variability, wearable devices, sympathetic activity, real-time monitoring
- MeSH terms
- Wearable Electronic Devices, Adult, Diabetes Mellitus, Type 1, Female, Heart Rate, Humans, Hypoglycemia, Male, Middle Aged, Early Diagnosis
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