{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:09:06Z","timestamp":1778476146591,"version":"3.51.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with increased heart rate (HR) and reduced heart rate variability (HRV) in patients with type 2 diabetes mellitus (T2DM). While sodium-glucose co-transporter 2 inhibitors (SGLT2i) may exert beneficial effects on cardiac autonomic function, it remains uncertain whether baseline SGLT2i use is associated with attenuation of GLP-1 RA-related HRV decline in T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective observational study, 45 patients with T2DM were divided into two groups according to pre-study dapagliflozin use: a dapagliflozin-na\u00efve group (Control group, n=22) and a dapagliflozin-exposed group (DAPA group, n=23). All participants subsequently received GLP-1 RA therapy for 12 weeks. Changes in HRV parameters were assessed by 24-hour ambulatory electrocardiography before and after treatment. Between-group differences were further evaluated using analysis of covariance (ANCOVA), inverse probability of treatment weighting (IPTW), and multivariable linear regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After 12 weeks of GLP-1 RA therapy, the Control group showed significant reductions in SDNN, SDANN, RMSSD, pNN50, and lnHF, together with increases in lnLF and the lnLF\/lnHF ratio, whereas no significant within-group changes in HRV indices were observed in the DAPA group. In unadjusted between-group analyses, several HRV parameters differed significantly between groups. After covariate adjustment, significant between-group differences remained for SDNN, SDANN, lnHF, and the lnLF\/lnHF ratio. IPTW-weighted sensitivity analyses yielded consistent findings. In multivariable regression, baseline dapagliflozin use was most clearly associated with a more favorable change in SDNN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with T2DM, dapagliflozin use was associated with a decline in HRV during GLP-1 RA therapy; these findings are hypothesis-generating and require confirmation in larger prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1809146","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:25:35Z","timestamp":1778473535000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dapagliflozin associates with heart rate variability decline in T2DM patients on GLP-1 receptor agonist therapy: a prospective observational study"],"prefix":"10.3389","volume":"17","author":[{"given":"Ying","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Affiliated Nanjing Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongning","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Nanjing Hospital of Nanjing Medical University","place":["Nanjing, China"]},{"name":"Department of Endocrinology, Lishui District People\u2019s Hospital","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Nanjing Tongren Hospital","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaocen","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated 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