{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:42:25Z","timestamp":1777556545047,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003092","name":"Diabetes Fonds","doi-asserted-by":"publisher","award":["2016.30.004"],"award-info":[{"award-number":["2016.30.004"]}],"id":[{"id":"10.13039\/501100003092","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Diabetes Sci Technol"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People with impaired awareness of hypoglycemia (IAH) are at elevated risk of severe, potentially hazardous, hypoglycemia and would benefit from a device alerting to hypoglycemia. Heart rate variability (HRV) changes with hypoglycemia due to sympathetic activity. Since IAH is associated with suppressed sympathetic activity, we investigated whether hypoglycemia elicits a measurable change in HRV in patients with T1D and IAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Eligible participants underwent a modified hyperinsulinemic euglycemic hypoglycemic clamp (glucose nadir, 43.1 \u00b1 0.90\u2009mg\/dl), while HRV was measured by a VitalConnect HealthPatch. Measurements of HRV included Root Mean Square of the Successive Differences (RMSSD) and low to high frequency (LF:HF) ratio. Wilcoxon rank-sum test was used for testing within-subject HRV changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 12 participants (8 female, mean age 57 \u00b1 12\u2009years, mean HbA1c 57 \u00b1 5\u2009mmol\/mol (7.4 \u00b1 0.4%)). Symptoms increased from 4.0 (1.5-7.0) at euglycemia to 7.5 (5.0-11.0) during hypoglycemia ( P = .003). In response to hypoglycemia, the LF:HF ratio and RMSSD increased when normalized for data obtained during euglycemia (both P &lt; .01). The LF:HF ratio increased in 6 participants (50%) and declined in one other participant (8%). The RMSSD decreased in 3 (25%) and increased in 4 (33%) participants. In 2 patients, no change in HRV could be detected in response to hypoglycemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study reveals that hypoglycemia-induced changes in HRV are retained in the majority of people with T1D and IAH, and that these changes can be detected by a wearable device. Real-time HRV seems usable for detection of hypoglycemia in patients with IAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19322968211007485","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T14:23:55Z","timestamp":1618496635000},"page":"1144-1149","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Effect of Hypoglycemia on Heart Rate Variability in People with Type 1 Diabetes and Impaired Awareness of Hypoglycemia"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7336-7135","authenticated-orcid":false,"given":"Mats","family":"Koeneman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"REshape Innovation Center, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marleen","family":"Olde Bekkink","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lian van","family":"Meijel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Bredie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"REshape Innovation Center, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bastiaan","family":"de Galan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands"},{"name":"CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"bibr1-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4127"},{"key":"bibr2-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2005.01501.x"},{"key":"bibr3-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2008.02413.x"},{"key":"bibr4-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-000935"},{"key":"bibr5-19322968211007485","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0279"},{"key":"bibr6-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.16107"},{"key":"bibr7-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1177\/1932296816653411"},{"key":"bibr8-19322968211007485","doi-asserted-by":"publisher","DOI":"10.2337\/diab.42.11.1683"},{"key":"bibr9-19322968211007485","doi-asserted-by":"publisher","DOI":"10.2337\/db18-2175-PUB"},{"key":"bibr10-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2016.0011"},{"key":"bibr11-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-006-0119-0"},{"key":"bibr12-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2830"},{"key":"bibr13-19322968211007485","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.3.744"},{"key":"bibr14-19322968211007485","doi-asserted-by":"publisher","DOI":"10.1109\/10.43621"},{"key":"bibr15-19322968211007485","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1843"},{"issue":"1","key":"bibr16-19322968211007485","volume":"287","author":"DeRosa 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