{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:22:38Z","timestamp":1789395758337,"version":"build-2803163510"},"reference-count":0,"publisher":"American Diabetes Association","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100007173","name":"Bio-oriented Technology Research Advancement Institution, Japan","doi-asserted-by":"crossref","award":["SIP2B"],"award-info":[{"award-number":["SIP2B"]}],"id":[{"id":"10.13039\/501100007173","id-type":"DOI","asserted-by":"crossref"}]},{"name":"JSPS KAKENHI","award":["JP20J15095 and JP23K19889"],"award-info":[{"award-number":["JP20J15095 and JP23K19889"]}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>While insulin activates the sympathetic nervous system in experimental settings, whether therapeutic insulin administration is associated with cardiac sympathetic predominance under free-living conditions remains unclear. This prospective observational study investigated the association between insulin dosing and cardiac autonomic balance in adults with type 1 diabetes managed exclusively with insulin therapy. Participants underwent continuous heart rate variability (HRV) and glucose monitoring over 4 consecutive days during routine daily activities. Cardiac sympathetic predominance was assessed using the low-frequency power to high-frequency power (LF\/HF) ratio derived from HRV analysis, and associations were evaluated using generalized estimating equations. A higher last bolus insulin dose was associated with an increased LF\/HF ratio during the early sleep phase. A higher basal insulin dose was also associated with an increased LF\/HF ratio during the late sleep phase. These associations persisted after adjustment for mean glucose and mean absolute glucose change during the corresponding sleep phases. Under free-living conditions, higher insulin doses were associated with dose-dependent increases in cardiac sympathetic predominance, independent of glycemic profiles. These findings suggest that insulin dosing may be linked to cardiac autonomic regulation in individuals with type 1 diabetes, highlighting the importance of considering cardiac autonomic balance and potential cardiovascular risk when optimizing insulin therapy.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Article Highlights<\/jats:title>\n                    <jats:p>The relationship between therapeutic insulin administration and cardiac autonomic balance under free-living conditions remains unclear. We examined whether insulin dosing was associated with cardiac sympathetic predominance during daily life in adults with type 1 diabetes managed with insulin therapy. Higher last bolus and basal insulin doses were associated with increased cardiac sympathetic predominance during the early and late sleep phases, respectively, independent of glycemic profiles. These findings suggest that insulin dosing patterns may be linked to cardiac autonomic balance, with potential implications for optimizing insulin therapy in type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/db26-0456","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:02:08Z","timestamp":1789394528000},"update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Insulin Dosing Is Associated With Cardiac Sympathetic Predominance Independent of Glycemic Profiles in Type 1 Diabetes Under Free-Living Conditions"],"prefix":"10.2337","author":[{"given":"Aki","family":"Kondo","sequence":"first","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2273-9693","authenticated-orcid":false,"given":"Kaori","family":"Ikeda","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"2Department of Clinical Research Facilitation, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizuka","family":"Kaneko","sequence":"additional","affiliation":[{"name":"3Division of Diabetes\/Endocrinology\/Lifestyle-Related Disease, Takatsuki Red Cross Hospital, Takatsuki, Japan"},{"name":"4Department of Diabetes and Endocrinology, Wakayama Red Cross Hospital, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Harashima","sequence":"additional","affiliation":[{"name":"5Department of Internal Medicine, Kyoto Goshominami Harashima Clinic, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keizo","family":"Furukawa","sequence":"additional","affiliation":[{"name":"6Department of Cardiology, Kyoto Tanabe Central Hospital, Kyotanabe, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuaki","family":"Nagashima","sequence":"additional","affiliation":[{"name":"7Department of Diabetes and Endocrinology, Kyoto-Katsura Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahito","family":"Ogura","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"8Department of Diabetes, Kyoto Tanabe Central Hospital, Kyotanabe, Japan"},{"name":"9Diabetes Center, NHO Kyoto Medical Center, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Fujita","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoko","family":"Ueba","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"3Division of Diabetes\/Endocrinology\/Lifestyle-Related Disease, Takatsuki Red Cross Hospital, Takatsuki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Motohashi","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"3Division of Diabetes\/Endocrinology\/Lifestyle-Related Disease, Takatsuki Red Cross Hospital, Takatsuki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachiko","family":"Tsukamoto-Kawashima","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"10Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi","family":"Okamura","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"8Department of Diabetes, Kyoto Tanabe Central Hospital, Kyotanabe, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumika","family":"Mano-Usui","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuya","family":"Inagaki","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"},{"name":"11Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-kofukai, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Yabe","sequence":"additional","affiliation":[{"name":"1Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,9,14]]},"container-title":["Diabetes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/diabetes\/article-pdf\/doi\/10.2337\/db26-0456\/894298\/db260456.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/diabetes\/article-pdf\/doi\/10.2337\/db26-0456\/894298\/db260456.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:02:09Z","timestamp":1789394529000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/diabetes\/article\/doi\/10.2337\/db26-0456\/172497\/Insulin-Dosing-Is-Associated-With-Cardiac"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2337\/db26-0456","relation":{},"ISSN":["0012-1797","1939-327X"],"issn-type":[{"value":"0012-1797","type":"print"},{"value":"1939-327X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"article-number":"db260456"}}