{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:33:42Z","timestamp":1792020822253,"version":"4.4.0"},"reference-count":43,"publisher":"American Diabetes Association","issue":"3","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2005,3,1]]},"abstract":"<jats:p>OBJECTIVE\u2014To describe the progression of autonomic impairment among individuals with diabetes and pre-diabetic metabolic impairments.<\/jats:p>\n                  <jats:p>RESEARCH DESIGN AND METHODS\u2014We investigated the consequence of diabetes and pre-diabetic metabolic impairments on the 9-year change in heart rate variability (HRV) in a population-based cohort of 6,245 individuals aged 45\u201364 years at baseline and cross-sectional associations among 9,940 individuals.<\/jats:p>\n                  <jats:p>RESULTS\u2014Diabetic subjects had a more rapid temporal decrease in HRV conditional on baseline HRV than nondiabetic subjects. Adjusted mean annual changes (95% CI) (ms\/year) in the SD of all normal-to-normal R-R intervals were \u22120.65 (\u22120.69 to \u22120.61) for those with normal fasting glucose vs. \u22120.95 (\u22121.09 to \u22120.81) for diabetic subjects, in root mean square of successive differences in normal-to-normal R-R intervals \u22120.35 (\u22120.39 to \u22120.30) vs. \u22120.66 (\u22120.82 to \u22120.51), and in R-R interval 6.70 (6.37\u20137.04) vs. 3.89 (2.72\u20135.05). While we found cross-sectional associations between decreased HRV and diabetes and nondiabetic hyperinsulinemia and a weak inverse association with fasting glucose, neither impaired fasting glucose nor nondiabetic hyperinsulimenia was associated with a measurably more rapid decline in HRV than normal.<\/jats:p>\n                  <jats:p>CONCLUSIONS\u2014Cardiac autonomic impairment appears to be present at early stages of diabetic metabolic impairment, and progressive worsening of autonomic cardiac function over 9 years was observed in diabetic subjects. The degree to which pre-diabetic metabolic impairments in insulin and glucose metabolism contribute to decreases in cardiac autonomic function remains to be determined.<\/jats:p>","DOI":"10.2337\/diacare.28.3.668","type":"journal-article","created":{"date-parts":[[2007,3,5]],"date-time":"2007-03-05T17:51:27Z","timestamp":1173117087000},"page":"668-674","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":251,"title":["Diabetes, Glucose, Insulin, and Heart Rate Variability"],"prefix":"10.2337","volume":"28","author":[{"given":"Emily B.","family":"Schroeder","sequence":"first","affiliation":[{"name":"Duke University School of Medicine, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd E.","family":"Chambless","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duanping","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Prineas","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory W.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne D.","family":"Rosamond","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Heiss","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","reference":[{"key":"2022031218423876200_R1","doi-asserted-by":"crossref","unstructured":"Freeman R: Diabetic autonomic neuropathy: an overview. 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