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Ehrmann D, Chatwin H, Schmitt A, Soeholm U, Kulzer B, Axelsen JL, Broadley M, Haak T, Pouwer F, Hermanns N. Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA-LINK1 study. Diabet Med 2023; 40:e15040. [PMID: 36625417 DOI: 10.1111/dme.15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
AIMS People with type 1 diabetes have a higher risk for cardiovascular disease (CVD). Reduced heart rate variability (HRV) is a clinical marker for CVD. In this observational study using continuous HRV measurement across 26 days, we investigated whether psychological stressors (diabetes distress, depressive symptoms) and glycaemic parameters (hypo- and hyperglycaemic exposure, glycaemic variability and HbA1c ) are associated with lower HRV in people with type 1 diabetes. METHODS Data from the non-interventional prospective DIA-LINK1 study were analysed. At baseline, depressive symptoms and diabetes distress were assessed. Glucose values and HRV were recorded daily for 26 days using continuous glucose monitoring (CGM) and a wrist-worn health tracker respectively. Multilevel modelling with participant as nesting factor was used to analyse associations between day-to-day HRV and diabetes distress, depressive symptoms and CGM-derived parameters. RESULTS Data from 149 participants were analysed (age: 38.3 ± 13.1 years, HbA1c : 8.6 ± 1.9%). Participants with elevated diabetes distress had a significantly lower HRV across the 26 days compared to participants without elevated distress (β = -0.28; p = 0.004). Elevated depressive symptoms were not significantly associated with HRV (β = -0.18; p = 0.074). Higher daily exposure to hyperglycaemia (β = -0.44; p = 0.044), higher average exposure to hypoglycaemia (β = -0.18; p = 0.042) and higher HbA1c (β = -0.20; p = 0.018) were associated with reduced HRV across the 26 days. Sensitivity analysis with HRV averaged across all days corroborated these results. CONCLUSIONS Diabetes distress is a clinically meaningful psychosocial stressor that could play a role in the cardiovascular health of people with type 1 diabetes. These findings highlight the need for integrated psychosocial care in diabetes management.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- National Centre for Register-Based Research (NCRR), Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
| | - Uffe Soeholm
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
| | | | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Thomas Haak
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Centre Odense (SDCO), Odense, Denmark
- Department of Medical Psychology, 1117 Amsterdam UMC, Amsterdam, The Netherlands
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
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