Diabetes, glucose, insulin, and heart rate variability: The Atherosclerosis Risk in Communities (ARIC) study

Emily B. Schroeder, Lloyd E. Chambless, Duanping Liao, Ronald J. Prineas, Gregory W. Evans, Wayne D. Rosamond, Gerardo Heiss

Research output: Contribution to journalArticlepeer-review

274 Scopus citations


OBJECTIVE - To describe the progression of autonomic impairment among individuals with diabetes and pre-diabetic metabolic impairments. RESEARCH DESIGN AND 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.

Original languageEnglish (US)
Pages (from-to)668-674
Number of pages7
JournalDiabetes care
Issue number3
StatePublished - Mar 2005

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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