Li AQ, Zhang F. Blood glucose variability impacts heart rate dynamics in older type 2 diabetic and coronary heart disease patients. World J Diabetes 2025; 16(10): 110722 [PMID: 41113498 DOI: 10.4239/wjd.v16.i10.110722]
Corresponding Author of This Article
Feng Zhang, Department of Neurosurgery, Hengyang Central Hospital, No. 12 Yancheng Road, Hengyang 421000, Hunan Province, China. zhangfeng1386@hotmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Oct 15, 2025; 16(10): 110722 Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.110722
Blood glucose variability impacts heart rate dynamics in older type 2 diabetic and coronary heart disease patients
An-Qi Li, Feng Zhang
An-Qi Li, Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421000, Hunan Province, China
Feng Zhang, Department of Neurosurgery, Hengyang Central Hospital, Hengyang 421000, Hunan Province, China
Author contributions: Li AQ wrote the paper, designed the research and analyzed the data; Li AQ and Zhang F performed the research; all authors made substantial intellectual contributions to this paper.
Supported by National Natural Science Foundation of China, No. 82270939; The Clinical Research 4310 Program of the First Affiliated Hospital of the University of South China, No. 20214310NHYCG02.
Institutional review board statement: This study was approved by the Ethic Committee of The First Affiliated Hospital, Hengyang Medical School, University of South China.
Informed consent statement: All the study subjects provided informed consent.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Zhang, Department of Neurosurgery, Hengyang Central Hospital, No. 12 Yancheng Road, Hengyang 421000, Hunan Province, China. zhangfeng1386@hotmail.com
Received: June 27, 2025 Revised: August 1, 2025 Accepted: September 16, 2025 Published online: October 15, 2025 Processing time: 110 Days and 1.4 Hours
Abstract
BACKGROUND
Cardiac autonomic neuropathy correlates intimately with cardiovascular complications and unexpected death. It is a typical clinical abnormality seen in coronary artery disease-affected individuals with concurrent type 2 diabetes mellitus (T2DM). Moreover, blood glucose (BG) variability has been clinically shown to induce cardiovascular events and sudden death.
AIM
To investigate how BG variability impacts heart rate (HR) dynamics in older adults with T2DM + coronary heart disease (CHD) and to evaluate the ability of functional myocardial ischemia to predict outcomes in this cohort.
METHODS
We enrolled 143 older T2DM + CHD patients admitted to the First Affiliated Hospital, Hengyang Medical School, University of South China over a 3.5-year period (January 2018 to July 2021). Using a standard deviation of BG cutoff of 1.4 mmol/L, subjects were stratified into abnormal (n = 75) and normal (n = 68) fluctuation groups. All patients underwent 72-hour dynamic BG monitoring to detect BG fluctuation parameters. The time domain index of HR variability was measured by dynamic electrocardiogram. To determine how well glucose fluctuation measures predicted functional myocardial ischemia, the area under the receiver operating characteristic curve (AUC) was calculated.
RESULTS
The abnormal fluctuation group showed greater levels of mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), largest amplitude of glycemic excursions (LAGE), and mean postprandial glucose excursions (MPPGE) relative to the normal group (P < 0.05), along with lower levels of standard deviation of normal-to-normal (NN) interval (SDNN), standard deviation of the average NN interval (SDANN), standard deviation of NN intervals over every 5-minute period (SDNNindex), root mean square of successive differences (rMSSD), and percentage of NN intervals differing by > 50 ms (pNN50; P < 0.05). Pearson correlation analysis showed that MAGE, MODD, LAGE, and MPPGE were negatively correlated with SDNN, SDANN, SDNNindex, rMSSD, and pNN50 in older patients with T2DM complicated by CHD (P < 0.05). The AUC of MAGE combined with MPPGE in predicting the occurrence of functional myocardial ischemia was 0.912, which was significantly higher than 0.694 of SDNN (P < 0.05).
CONCLUSION
A negative correlation was found between BG variability and HR dynamics in older CHD + T2DM patients, and MAGE combined with MPPGE demonstrated better efficacy in predicting functional myocardial ischemia, which deserves clinical attention.
Core Tip: Recent evidence has linked cardio-cerebrovascular events in type 2 diabetes mellitus patients with concurrent coronary artery disease to blood glucose (BG) fluctuation, and the greater the BG fluctuation, the higher the incidence of chronic vascular complications of diabetes mellitus and acute cardiovascular events, and the worse the prognosis. This study analyzes how BG variability impacts heart rate dynamics in such patients and the predictive properties of functional myocardial ischemia.
