title: Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study.
abstract: OBJECTIVE
  To describe the progression of autonomic impairment among individuals with diabetes and pre-diabetic metabolic impairments.
  
  
  METHODS
  We investigated the consequence of diabetes and pre-diabetic metabolic impairments on the 9-year change in heart rate variability (HRV) in a population-based cohort of 6,245 individuals aged 45-64 years at baseline and cross-sectional associations among 9,940 individuals.
  
  
  RESULTS
  Diabetic subjects had a more rapid temporal decrease in HRV conditional on baseline HRV than nondiabetic subjects. Adjusted mean annual changes (95% CI) (ms/year) in the SD of all normal-to-normal R-R intervals were -0.65 (-0.69 to -0.61) for those with normal fasting glucose vs. -0.95 (-1.09 to -0.81) for diabetic subjects, in root mean square of successive differences in normal-to-normal R-R intervals -0.35 (-0.39 to -0.30) vs. -0.66 (-0.82 to -0.51), and in R-R interval 6.70 (6.37-7.04) vs. 3.89 (2.72-5.05). While we found cross-sectional associations between decreased HRV and diabetes and nondiabetic hyperinsulinemia and a weak inverse association with fasting glucose, neither impaired fasting glucose nor nondiabetic hyperinsulimenia was associated with a measurably more rapid decline in HRV than normal.
  
  
  CONCLUSIONS
  Cardiac autonomic impairment appears to be present at early stages of diabetic metabolic impairment, and progressive worsening of autonomic cardiac function over 9 years was observed in diabetic subjects. The degree to which pre-diabetic metabolic impairments in insulin and glucose metabolism contribute to decreases in cardiac autonomic function remains to be determined.
authors.affiliation: Duke University School of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Schroeder
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Duanping
authors.initials: D
authors.lastname: Liao
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Prineas
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Evans
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D001161:Arteriosclerosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012907:Smoking
chemical_list: D007328:Insulin