Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA-LINK1 study

Diabet Med. 2023 Apr;40(4):e15040. doi: 10.1111/dme.15040. Epub 2023 Jan 26.

Abstract

Aims: People with type 1 diabetes have a higher risk for cardiovascular disease (CVD). Reduced heart rate variability (HRV) is a clinical marker for CVD. In this observational study using continuous HRV measurement across 26 days, we investigated whether psychological stressors (diabetes distress, depressive symptoms) and glycaemic parameters (hypo- and hyperglycaemic exposure, glycaemic variability and HbA1c ) are associated with lower HRV in people with type 1 diabetes.

Methods: Data from the non-interventional prospective DIA-LINK1 study were analysed. At baseline, depressive symptoms and diabetes distress were assessed. Glucose values and HRV were recorded daily for 26 days using continuous glucose monitoring (CGM) and a wrist-worn health tracker respectively. Multilevel modelling with participant as nesting factor was used to analyse associations between day-to-day HRV and diabetes distress, depressive symptoms and CGM-derived parameters.

Results: Data from 149 participants were analysed (age: 38.3 ± 13.1 years, HbA1c : 8.6 ± 1.9%). Participants with elevated diabetes distress had a significantly lower HRV across the 26 days compared to participants without elevated distress (β = -0.28; p = 0.004). Elevated depressive symptoms were not significantly associated with HRV (β = -0.18; p = 0.074). Higher daily exposure to hyperglycaemia (β = -0.44; p = 0.044), higher average exposure to hypoglycaemia (β = -0.18; p = 0.042) and higher HbA1c (β = -0.20; p = 0.018) were associated with reduced HRV across the 26 days. Sensitivity analysis with HRV averaged across all days corroborated these results.

Conclusions: Diabetes distress is a clinically meaningful psychosocial stressor that could play a role in the cardiovascular health of people with type 1 diabetes. These findings highlight the need for integrated psychosocial care in diabetes management.

Keywords: cardiovascular health; depression; diabetes distress; heart rate variability; type 1 diabetes.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Blood Glucose Self-Monitoring
  • Cardiovascular Diseases*
  • Diabetes Mellitus, Type 1*
  • Heart Rate / physiology
  • Humans
  • Middle Aged
  • Prospective Studies

Substances

  • Blood Glucose