A new study published in the Journal of Clinical Endocrinology & Metabolism suggests that type 2 diabetes development is preceded by autonomic dysfunction, particularly in younger people.
Cardiovascular problems in type 2 diabetes mellitus have been linked to cardiac autonomic dysfunction brought on by hyperglycemia. Heart rate variability (HRV), a sign of cardiac autonomic dysfunction, has been linked to variations in fasting blood sugar levels and the occurrence of type 2 diabetes (T2D). In this study, Kan Wang and colleagues looked at the relationship between type 2 diabetes incidence in the general population and the longitudinal evolution of heart rate variability.

7630 individuals from the population-based Rotterdam Study who underwent repeated HRV tests at baseline and during follow-up and had no prior history of T2D or atrial fibrillation were included (mean age 63.7 years; 58% women). Joint models were used to analyze the relationship between longitudinal heart rate evolution and various HRV metrics, such as the root mean square of successive RR-interval differences (RMSSDc) and the heart-rate corrected standard deviation of the normal-to-normal RR intervals (SDNNc), with incident type 2 diabetes. Models had their risk factors for cardiovascular disease modified. Additionally, summary-level data were used in a bidirectional Mendelian randomization.
The key findings of this study were:

1. In the course of a median follow-up of 8.6 years, 871 people experienced incident T2D.
2. Incidence of type 2 diabetes (T2D) was independently linked with a one standard deviation (SD) rise in heart rate (hazard ratio [HR], 1.20, 95% confidence interval (CI), 1.09-1.33) and log (RMSSDc) (1.16, 95% CI 1.01-1.33).
3. For individuals under 62 years old, the HRs were 1.54 (95% CI 1.08-2.06) and for those over 62 years old, the HRs were 1.15 (95% CI 1.01-1.31) (p for interaction 0.001).
4. Bidirectional MR analysis findings revealed that there was no significant relationship between HRV and T2D.
The chance of developing T2D was dramatically enhanced, especially in younger people, by high heart rate and HRV. This is the first prospective study looking at the role of autonomic dysfunction in the onset of T2D utilizing repeated measures of heart rate and HRV. More research is required to confirm our findings and clarify the underlying processes in more detail.
Reference:
Wang, K., Ahmadizar, F., Geurts, S., Arshi, B., Kors, J. A., Rizopoulos, D., Sijbrands, E. J. G., Ikram, M. A., & Kavousi, M. (2023). Heart rate variability and incident type 2 diabetes in general population. In The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society. https://doi.org/10.1210/clinem/dgad200