• Autonomic Ewings battery of tests
• autonomic function testing
• diabetic autonomic neuropathy
• heart rate variability
• high frequency
• low frequency
• total power

• cardiac autonomic neuropathy
• meta-analysis
• prevalence
• type 1 diabetes mellitus

• clinical trial design
• diabetes complications
• type 1 diabetes
• neurological disorders
• cardiovascular diseases

• Humans
• Blood Pressure/physiology
• Blood Pressure Monitoring, Ambulatory
• Cholecalciferol/therapeutic use
• Circadian Rhythm/physiology
• Diabetes Mellitus, Type 1/complications
• Diabetes Mellitus, Type 1/drug therapy
• Dietary Supplements
• Hypertension
• Hypotension
• Prospective Studies

• Heart rate variability
• Nerve conduction
• Orthostatic hypotension

• Humans
• Middle Aged
• Electrocardiography
• Retrospective Studies
• Autonomic Nervous System Diseases/etiology
• Autonomic Nervous System Diseases/diagnosis
• Diabetic Neuropathies/diagnosis
• Peripheral Nerves
• Heart Rate
• Blood Pressure
• Diabetes Mellitus

• Arterial stiffness
• Cardiac autonomic neuropathy
• Cardio-ankle vascular index
• Cardiovascular disease
• Heart rate variation
• Pulse wave velocity

Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter—glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters.

The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management.

A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts.

On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices.

Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions.

• big data
• consumer health informatics
• mobile health
• survey
• type 1 diabetes
• wearable sensors

Mental illness represents a major global burden of disease worldwide. It has been hypothesised that individuals with mental illness have greater blood pressure fluctuations that lead to increased cardiovascular risk and target organ damage. This systematic review aims to (i) investigate the association between mental illness and blood pressure variability (BPV) and (ii) describe methods of BPV measurements and analysis which may affect pattern and degree of variability.

Four electronic databases were searched from inception until 2020. The quality assessment was performed using STROBE criteria. Studies were included if they investigated BPV (including either frequency or time domain analysis) in individuals with mental illness (particularly anxiety/generalised anxiety disorder, depression/major depressive disorder, panic disorder and hostility) and without hypertension. Two authors independently screened titles, abstracts and full texts. A third author resolved any disagreements.

Twelve studies met the inclusion criteria. Three studies measured short-term BPV, two measured long-term BPV and seven measured ultra-short-term BPV. All studies related to short-term BPV using ambulatory and home blood pressure monitoring found a higher BPV in individuals with depression or panic disorder. The two studies measuring long-term BPV were limited to the older population and found mixed results. Mental illness is significantly associated with an increased BPV in younger and middle-aged adults. All studies of ultra-short-term BPV using standard cardiac autonomic assessment; non-invasive continuous finger blood pressure and heart rate signals found significant association between BPV and mental illness. A mixed result related to degree of tilt during tilt assessment and between controlled and spontaneous breathing were observed in patients with psychological state.

Current review found that people with mental illness is significantly associated with an increased BPV regardless of age. Since mental illness can contribute to the deterioration of autonomic function (HRV, BPV), early therapeutic intervention in mental illness may prevent diseases associated with autonomic dysregulation and reduce the likelihood of negative cardiac outcomes. Therefore, these findings may have important implications for patients' future physical health and well-being, highlighting the need for comprehensive cardiovascular risk reduction.

• Autonomic nervous system
• Blood pressure variability
• Mental disorder
• Spectral analysis
• Time-domain analysis

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier, even before diabetes is diagnosed. CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers, which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control. The entire mechanism is still not elucidated, but several aspects of the pathophysiology of CAN have already been described, such as the production of advanced glycation end products, reactive oxygen species, nuclear factor kappa B, and pro-inflammatory cytokines. This microvascular complication is an important risk factor for silent myocardial ischemia, chronic kidney disease, myocardial dysfunction, major cardiovascular events, cardiac arrhythmias, and sudden death. It has also been suggested that, compared to other traditional cardiovascular risk factors, CAN progression may have a greater impact on cardiovascular disease development. However, CAN might be subclinical for several years, and a late diagnosis increases the mortality risk. The duration of the transition period from the subclinical to clinical stage remains unknown, but the progression of CAN is associated with a poor prognosis. Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

• Cardiovascular autonomic neuropathy
• Cardiac autonomic neuropathy
• Diabetes mellitus
• Heart rate variability
• Sympathetic autonomic nervous system
• Parasympathetic autonomic nervous system

• cardiovascular autonomic dysfunction
• cardiovascular autonomic neuropathy
• cardiovascular reflex tests
• complications
• glycaemic variability
• heart rate variability
• type 1 diabetes

• Autonomic Nervous System Diseases/etiology
• Autonomic Nervous System Diseases/pathology
• Blood Glucose/metabolism
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/pathology
• Diabetes Complications/etiology
• Diabetes Complications/pathology
• Diabetes Mellitus, Type 1/complications
• Humans
• Hyperglycemia/etiology
• Hyperglycemia/pathology
• Prognosis

• Ghent University

• autonomic nervous system
• cardiovascular autonomic neuropathy
• diabetes mellitus type 1
• heart rate
• vitamin D

• Adolescent
• Adult
• Autonomic Nervous System Diseases/drug therapy
• Autonomic Nervous System Diseases/etiology
• Autonomic Nervous System Diseases/pathology
• Blood Glucose/analysis
• Cardiovascular Diseases/drug therapy
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/pathology
• Child
• Diabetes Mellitus, Type 1/complications
• Diabetic Neuropathies/drug therapy
• Diabetic Neuropathies/etiology
• Diabetic Neuropathies/pathology
• Dietary Supplements
• Female
• Heart Rate
• Humans
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Vitamin D/administration & dosage
• Vitamins/administration & dosage
• Young Adult

• 30:15 ratio
• Ewing criteria
• Ewing tests
• Valsalva ratio
• autonomic
• cardiovascular
• deep breathing
• heart-rate variability
• hyperglycemia
• neuropathy
• orthostatic hypotension
• parasympathetic
• postural hypotension
• sympathetic

• CS-2013-13-029 Department of Health