Dysglycaemia and Autonomic Dysfunction: The Diabetes Prevention Program Outcomes Study.

AIM: Limited data on the link between various measures of glycemia and metabolism and autonomic dysfunction exist. We assessed the association of fasting plasma glucose [FPG], glycated haemoglobin [HbA1C], fasting insulin, and HOMA-IR and cardiac autonomic function measures separately for men and women in the Diabetes Prevention Program Outcomes Study (DPPOS). METHODS: We included DPPOS participants with ECG-based heart rate variability (HRV) measured at the 10-year examination. Resting heart rate (HR), standard deviation of all normal-to-normal intervals (SDNN), and root mean square of successive differences between normal-to-normal intervals (rMSSD) were measured. Multivariable linear regression models assessed the cross-sectional associations of FPG, HbA1C, and fasting insulin and HOMA-IR with cardiac autonomic function measures. RESULTS: Among 2266 participants (mean age 65 years, 68.2% women, 53.4% White, 43.7% with prediabetes and 56.3% with diabetes at the time of evaluation), HbA1C, FPG, fasting insulin and HOMA IR were positively associated with high resting HR in men and women. HbA1C and FPG were inversely associated with rMSSD (β [95% CI] per SD: -0.08 [-0.14, -0.03] and -0.08 [-0.13, -0.03]) and SDNN (-0.08 [-0.12, -0.03] and -0.07 [-0.11, -0.02]) among women, but not in men. Fasting insulin was inversely associated with rMSSD in the men (-0.09 [-0.18, 0.00]). HOMA-IR was inversely associated with rMSSD in men (-0.11 [-0.20, -0.02] and women -0.07 [-0.12, -0.02]). HOMA-IR was associated with SDNN only in women (-0.05 [-0.10, 0.00]). CONCLUSIONS: Markers of dysglycaemia are associated with worse ECG-based autonomic dysfunction in adults with prediabetes and diabetes in the DPPOS, more so for some glycaemic markers and in women.