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Abstract

Click to add/remove this article to your list of 'My Favorites' Autonomic Nervous System Dysfunction, and Incident Diabetes

Year: 2005

Abstract Number: 1003-P

Authors: DIABETES PREVENTION PROGRAM RESEARCH GROUP

Institutions: Rockville, MD

Results: Inactivity, poor fitness, and obesity may explain reported associations between autonomic nervous system (ANS) dysfunction and incident diabetes. Our post-hoc analysis of the DPP, tested whether changes in estimates of ANS function were more favorable in the lifestyle (ILS) vs. metformin (MET) or placebo arms, and whether ANS function predicted the development of diabetes over 3.2 years. Baseline and annual 12-lead ECGs were collected in 2980 (68% women) DPP participants free from CVD and who were not using anti-arrhythmic drugs. Heart rate (HR) and heart rate variability (HRV) indices were derived from R-R intervals to estimate a global measure of ANS function and fitness (HR), joint sympathetic and parasympathetic modulation of HR (standard deviation of normal R-R intervals [SDNN]), and parasympathetic modulation of HR (root mean square of successive differences between R-R intervals [rMSSD]). Incidence rates of diabetes (ADA criteria used) in the placebo, MET, and ILS arms were 10.6, 7.7, and 5.1 per 100 person-years, respectively. HR declined the most over time in the ILS arm (-4.7 bpm) vs. the placebo (-2.1 bpm) or MET (-1.9 bpm) arms (p<0.05 for both). SDNN and rMSSD increased favorably in the ILS arm (SDNN = 1.3 ms, rMSSD = 3.0 ms), while they decreased in the placebo (SDNN = -1.2 ms, rMSSD = -0.9 ms) and MET (SDNN = -0.6 ms, rMSSD = -0.3 ms) arms (p<0.05). Higher baseline HR was associated with elevated proportional hazards ratios for incident diabetes (Table, adjusted for age, race, sex) that persisted with adjustment for hypertension, physical activity and BMI in all arms except placebo. ILS was associated with favorable modification of all HRV indices and HR. HR, which reflects fitness as well as ANS function, was a modest predictor of incident diabetes in the DPP.

PlaceboMETILS
Baseline Index (per SD difference)Hazards ratio (95% CI)
HR (10.6 bpm)1.13 (1.01, 1.27)1.17 (1.03, 1.34)1.27 (1.08, 1.49)
SDNN (18.9 ms)1.01 (0.90, 1.14)0.88 (0.74, 1.05)0.94 (0.79, 1.13)
rMSSD (24.4 ms)0.99 (0.87, 1.11)0.87 (0.72, 1.04)0.87 (0.71, 1.08)

Category: Epidemiology