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Heart Rate Variability and Cardiac Autonomic Dysfunction: Prevalence, Risk Factors, and Relationship to Arterial Stiffness in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study.

  • Shah, Amy S1
  • El Ghormli, Laure2
  • Vajravelu, Mary Ellen3
  • Bacha, Fida4
  • Farrell, Ryan M5
  • Gidding, Samuel S6
  • Levitt Katz, Lorraine E3
  • Tryggestad, Jeanie B7
  • White, Neil H8
  • Urbina, Elaine M1
  • 1 Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
  • 2 George Washington University Biostatistics Center, Rockville, MD [email protected]
  • 3 Children's Hospital of Philadelphia, Philadelphia, PA.
  • 4 Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
  • 5 Case Western Reserve University, Cleveland, OH.
  • 6 FH Foundation, Pasadena, CA.
  • 7 University of Oklahoma Health Sciences Center, Oklahoma City, OK.
  • 8 Washington University in St. Louis, St. Louis, MO.
Published Article
Diabetes care
Publication Date
Nov 01, 2019
DOI: 10.2337/dc19-0993
PMID: 31501226


To determine whether prior type 2 diabetes (T2D) treatment or glycemic control over time are independently associated with heart rate variability (HRV) and whether the presence of cardiac autonomic dysfunction is associated with arterial stiffness in young adults with youth-onset T2D enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Heartbeats over 10 min were measured to derive the normal R-Rs (NN intervals). Outcomes included the standard deviation of the NN intervals (SDNN), the root mean square differences of successive NN intervals (RMSSD), percent of NN beats that differ by more than 50 ms (PNN50), and the low-frequency (LF) power domain, high-frequency (HF) power domain, and their ratio (LF:HF). Autonomic dysfunction was defined as ≥3 of 5 abnormal HRV indices compared with obese controls from a separate study. A total of 397 TODAY participants were evaluated 7 years after randomization. TODAY participants had reduced HRV (SDNN 58.1 ± 29.6 ms vs. controls 67.1 ± 25.4 ms; P < 0.0001) with parasympathetic loss (RMSSD 53.2 ± 36.7 ms vs. controls 67.9 ± 35.2 ms; P < 0.0001) with sympathetic overdrive (LF:HF ratio 1.4 ± 1.7 vs. controls 1.0 ± 1.1; P < 0.0001). Cardiac autonomic dysfunction was present in 8% of TODAY participants, and these participants had greater pulse wave velocity compared with those without dysfunction (P = 0.0001). HRV did not differ by randomized treatment, but higher hemoglobin A1c (HbA1c) over time was independently associated with lower SDNN and RMSSD and higher LF:HF ratio after adjustment for age, race-ethnicity, sex, and BMI. Young adults with youth-onset T2D show evidence of cardiac autonomic dysfunction with both parasympathetic and sympathetic impairments that are associated with higher HbA1c. © 2019 by the American Diabetes Association.

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