{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:13:41Z","timestamp":1791825221405,"version":"4.3.4"},"reference-count":125,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Type 2 diabetes mellitus is associated with major cardiovascular complications, including cardiac autonomic neuropathy, which contributes to sympathetic\u2013parasympathetic imbalance and increases susceptibility to arrhythmias and sudden cardiac death. Heart rate variability, assessed through R\u2013R intervals on electrocardiography and 24 h Holter monitoring, represents a sensitive, non-invasive marker of autonomic dysfunction and arrhythmogenic risk. In patients with type 2 diabetes mellitus, chronic hyperglycaemia, oxidative stress, and metabolic inflammation lead to early impairment of the autonomic nervous system, manifested by consistent reductions in SDNN, RMSSD, pNN50, total power, and the high-frequency component, indicating diminished parasympathetic tone and sympathetic predominance. Nonlinear HRV indices demonstrate a loss of complexity and fractal organisation, providing additional prognostic value beyond conventional time- and frequency-domain analyses. Reduced HRV correlates with the severity of cardiac autonomic neuropathy, duration of diabetes, and poor glycaemic control, identifying patients with increased arrhythmogenic vulnerability. HRV analysis enables prediction of arrhythmic risk, facilitating the identification of high-risk individuals and guiding personalised interventions. The integration of HRV assessment into routine clinical practice may improve the early detection of subclinical autonomic neuropathy and optimise cardiovascular risk stratification and management in patients with type 2 diabetes mellitus.<\/jats:p>","DOI":"10.3390\/life16030520","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"520","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["From Beat to Risk: How Heart Rate Variability Predicts Arrhythmias in Type 2 Diabetes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2874-9227","authenticated-orcid":false,"given":"Amelian Madalin","family":"Bobu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Iasi, Romania"},{"name":"Cardiology Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0218tefania-Teodora","family":"Duca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Grigore T. 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Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1016\/S0140-6736(24)02317-1","article-title":"Worldwide Trends in Diabetes Prevalence and Treatment from 1990 to 2022: A Pooled Analysis of 1108 Population-Representative Studies with 141 Million Participants","volume":"404","author":"Zhou","year":"2024","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1007\/s00125-025-06478-4","article-title":"Variation in Type 2 Diabetes Prevalence across Different Populations: The Key Drivers","volume":"68","author":"Gong","year":"2025","journal-title":"Diabetologia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2174\/1573403X1604201229115531","article-title":"Complications of the Type 2 Diabetes Mellitus","volume":"16","author":"Farmaki","year":"2020","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yang, D.-R., Wang, M.-Y., Zhang, C.-L., and Wang, Y. (2024). Endothelial Dysfunction in Vascular Complications of Diabetes: A Comprehensive Review of Mechanisms and Implications. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1359255"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Roy, B. (2025). Pathophysiological Mechanisms of Diabetes-Induced Macrovascular and Microvascular Complications: The Role of Oxidative Stress. Med. Sci., 13.","DOI":"10.3390\/medsci13030087"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1038\/s41598-022-27208-5","article-title":"Cardiovascular Risk Factors in Diabetic Patients with and without Metabolic Syndrome: A Study Based on the Rafsanjan Cohort Study","volume":"13","author":"Bazmandegan","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5374176","DOI":"10.1155\/2017\/5374176","article-title":"Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That?","volume":"2017","author":"Bissinger","year":"2017","journal-title":"J. Diabetes Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rolim, L.C., Souza, J.S.T., and Dib, S. (2013). Tests for Early Diagnosis of Cardiovascular Autonomic Neuropathy: Critical Analysis and Relevance. Front. Endocrinol., 4.","DOI":"10.3389\/fendo.2013.00173"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.2337\/dc10-1303","article-title":"Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments","volume":"33","author":"Tesfaye","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e002480","DOI":"10.1136\/bmjdrc-2021-002480","article-title":"Cardiac Autonomic Neuropathy and Risk of Cardiovascular Disease and Mortality in Type 1 and Type 2 Diabetes: A Meta-Analysis","volume":"9","author":"Chowdhury","year":"2021","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1161\/CIRCULATIONAHA.106.634949","article-title":"Diabetic Cardiovascular Autonomic Neuropathy","volume":"115","author":"Vinik","year":"2007","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12933-024-02185-3","article-title":"Prevalence and Prognostic Significance of Cardiac Autonomic Neuropathy in Community-Based People with Type 2 Diabetes: The Fremantle Diabetes Study Phase II","volume":"23","author":"Davis","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/dmrr.1239","article-title":"Cardiovascular Autonomic Neuropathy in Diabetes: Clinical Impact, Assessment, Diagnosis, and Management","volume":"27","author":"Spallone","year":"2011","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3576","DOI":"10.1038\/s41598-021-80962-w","article-title":"Correlation of Staging and Risk Factors with Cardiovascular Autonomic Neuropathy in Patients with Type II Diabetes Mellitus","volume":"11","author":"Dhumad","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1055\/s-2006-924083","article-title":"Selective Contribution of Diabetes and Other Cardiovascular Risk Factors to Cardiac Autonomic Dysfunction in the General Population","volume":"114","author":"Ziegler","year":"2006","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/brain\/98.3.341","article-title":"The Sympathetic Nervous System in Diabetic Neuropathy. A Clinical and Pathological Study","volume":"98","author":"Low","year":"1975","journal-title":"Brain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.jacc.2018.12.064","article-title":"Autonomic Nervous System Dysfunction","volume":"73","author":"Goldberger","year":"2019","journal-title":"JACC"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/j.clinthera.2022.09.002","article-title":"Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management","volume":"44","author":"Williams","year":"2022","journal-title":"Clin. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.2337\/diacare.27.6.1458","article-title":"Diabetic Somatic Neuropathies","volume":"27","author":"Boulton","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.2337\/dc10-0125","article-title":"Effects of Cardiac Autonomic Dysfunction on Mortality Risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial","volume":"33","author":"Evans","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1136\/heartjnl-2015-309181","article-title":"Inflammatory Markers Are Associated with Cardiac Autonomic Dysfunction in Recent-Onset Type 2 Diabetes","volume":"103","author":"Herder","year":"2017","journal-title":"Heart"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"855","DOI":"10.4239\/wjd.v12.i6.855","article-title":"Cardiovascular Autonomic Neuropathy in Diabetes: Pathophysiology, Clinical Assessment and Implications","volume":"12","author":"Duque","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1038\/s41598-023-27941-5","article-title":"Cardiac Arrhythmias and Conduction Abnormalities in Patients with Type 2 Diabetes","volume":"13","author":"Rawshani","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_26","first-page":"418","article-title":"Sudden Cardiac Death in Diabetes and Obesity: Mechanisms and Therapeutic Strategies","volume":"38","author":"Remme","year":"2022","journal-title":"Can. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2095-LB","DOI":"10.2337\/db25-2095-LB","article-title":"2095-LB: Incidence of Cardiac Arrhythmias in Patients with Diabetes\u2014A Real-World Study","volume":"74","author":"Russo","year":"2025","journal-title":"Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1016\/j.hrthm.2024.05.063","article-title":"Sudden Cardiac Death Due to Ventricular Arrhythmia in Diabetes Mellitus: A Bench to Bedside Review","volume":"21","author":"Chakraborty","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"918","DOI":"10.2337\/diacare.25.5.918","article-title":"Influence of Cardiac Autonomic Neuropathy on Heart Rate Dependence of Ventricular Repolarization in Diabetic Patients","volume":"25","author":"Valensi","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1111\/1753-0407.12908","article-title":"Nocturnal Ventricular Arrhythmias Are Associated with the Severity of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes","volume":"11","author":"Chen","year":"2019","journal-title":"J. Diabetes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1038\/nrendo.2012.21","article-title":"Cardiovascular Autonomic Neuropathies as Complications of Diabetes Mellitus","volume":"8","author":"Kuehl","year":"2012","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gallego, M., Zayas-Arrabal, J., Alquiza, A., Apellaniz, B., and Casis, O. (2021). Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.687256"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4239\/wjd.v12.i1.1","article-title":"Diabetes-Induced Changes in Cardiac Voltage-Gated Ion Channels","volume":"12","author":"Ozturk","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1159\/000430353","article-title":"High Glucose Represses hERG K+ Channel Expression through Trafficking Inhibition","volume":"37","author":"Shi","year":"2015","journal-title":"Cell. Physiol. Biochem."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Lin, H., Yang, Y., Wang, X., Chung, M., Zhang, L., Cai, S., Pan, X., and Pan, Y. (2025). Targeting the AGEs-RAGE Axis: Pathogenic Mechanisms and Therapeutic Interventions in Diabetic Wound Healing. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1667620"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1161\/CIRCRESAHA.119.316288","article-title":"Hyperglycemia Acutely Increases Cytosolic Reactive Oxygen Species via O-Linked GlcNAcylation and CaMKII Activation in Mouse Ventricular Myocytes","volume":"126","author":"Lu","year":"2020","journal-title":"Circ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Evangelista, I., Nuti, R., Picchioni, T., Dotta, F., and Palazzuoli, A. (2019). Molecular Dysfunction and Phenotypic Derangement in Diabetic Cardiomyopathy. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20133264"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Jubaidi, F.F., Zainalabidin, S., Taib, I.S., Abdul Hamid, Z., Mohamad Anuar, N.N., Jalil, J., Mohd Nor, N.A., and Budin, S.B. (2022). The Role of PKC-MAPK Signalling Pathways in the Development of Hyperglycemia-Induced Cardiovascular Complications. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23158582"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.yjmcc.2019.01.001","article-title":"CaMKII Signaling in Heart Diseases: Emerging Role in Diabetic Cardiomyopathy","volume":"127","author":"Hegyi","year":"2019","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1161\/CIRCRESAHA.120.318402","article-title":"CaMKII Serine 280 O-GlcNAcylation Links Diabetic Hyperglycemia to Proarrhythmia","volume":"129","author":"Hegyi","year":"2021","journal-title":"Circ. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1111\/brv.12866","article-title":"New Insight into Dyslipidemia-Induced Cellular Senescence in Atherosclerosis","volume":"97","author":"Xiang","year":"2022","journal-title":"Biol. Rev. Camb. Philos. Soc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/CIRCRESAHA.118.312708","article-title":"Mitochondrial ROS Drive Sudden Cardiac Death and Chronic Proteome Remodeling in Heart Failure","volume":"123","author":"Dey","year":"2018","journal-title":"Circ. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/0002-9378(65)90586-7","article-title":"The Fetal Electrocardiogram. 3. Display Techniques","volume":"91","author":"Hon","year":"1965","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Tarvainen, M.P., Laitinen, T.P., Lipponen, J.A., Cornforth, D.J., and Jelinek, H.F. (2014). Cardiac Autonomic Dysfunction in Type 2 Diabetes\u2014Effect of Hyperglycemia and Disease Duration. Front. Endocrinol., 5.","DOI":"10.3389\/fendo.2014.00130"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Eckstein, M.L., Brockfeld, A., Haupt, S., Schierbauer, J.R., Zimmer, R.T., Wachsmuth, N.B., Zunner, B.E.M., Zimmermann, P., Erlmann, M., and Obermayer-Pietsch, B. (2022). Acute Changes in Heart Rate Variability to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial. Biology, 11.","DOI":"10.3390\/biology11020338"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Benichou, T., Pereira, B., Mermillod, M., Tauveron, I., Pfabigan, D., Maqdasy, S., and Dutheil, F. (2018). Heart Rate Variability in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195166"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102651","DOI":"10.1016\/j.bspc.2021.102651","article-title":"Reliability of Heart-Rate-Variability Features Derived from Ultra-Short ECG Recordings and Their Validity in the Assessment of Cardiac Autonomic Neuropathy","volume":"68","author":"Wehler","year":"2021","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.2337\/dc19-2367","article-title":"Both Prediabetes and Type 2 Diabetes Are Associated With Lower Heart Rate Variability: The Maastricht Study","volume":"43","author":"Coopmans","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.1007\/s00125-024-06242-0","article-title":"Cardiovascular Autonomic Neuropathy in Diabetes: An Update with a Focus on Management","volume":"67","author":"Eleftheriadou","year":"2024","journal-title":"Diabetologia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1007\/s00421-019-04142-5","article-title":"RR Interval Signal Quality of a Heart Rate Monitor and an ECG Holter at Rest and during Exercise","volume":"119","author":"Schweizer","year":"2019","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Maleczek, M., Schebesta, K., Hamp, T., Laussner, B., Pezawas, T., Krammel, M., and Roessler, B. (2025). Association between Heart Rate Variability and ECG Changes in On-Duty Prehospital Physicians. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1617377"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Peltola, M. (2012). Role of Editing of R-R Intervals in the Analysis of Heart Rate Variability. Front. Physiol., 3.","DOI":"10.3389\/fphys.2012.00148"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"B\u00faz\u00e1s, A., Sonkodi, B., and D\u00e9r, A. (2025). Principal Connection Between Typical Heart Rate Variability Parameters as Revealed by a Comparative Analysis of Their Heart Rate and Age Dependence. Entropy, 27.","DOI":"10.20944\/preprints202505.0641.v2"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1093\/europace\/euv015","article-title":"Advances in Heart Rate Variability Signal Analysis: Joint Position Statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association Co-Endorsed by the Asia Pacific Heart Rhythm Society","volume":"17","author":"Sassi","year":"2015","journal-title":"Europace"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/jdi.13635","article-title":"DCCT\/EDIC Research Group Utility of Using Electrocardiogram Measures of Heart Rate Variability as a Measure of Cardiovascular Autonomic Neuropathy in Type\u20091 Diabetes Patients","volume":"13","author":"Backlund","year":"2022","journal-title":"J. Diabetes Investig."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Ortiz-Guzm\u00e1n, J.E., Moll\u00e0-Casanova, S., Serra-A\u00f1\u00f3, P., Arias-Mutis, \u00d3.J., Calvo, C., Bizy, A., Alberola, A., Chorro, F.J., and Zarzoso, M. (2023). Short-Term Heart Rate Variability in Metabolic Syndrome: A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12186051"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.2337\/dc19-0993","article-title":"Heart Rate Variability and Cardiac Autonomic Dysfunction: Prevalence, Risk Factors, and Relationship to Arterial Stiffness in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study","volume":"42","author":"Shah","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"H985","DOI":"10.1152\/ajpheart.1991.260.3.H985","article-title":"SA Nodal Parasympathectomy Delineates Autonomic Control of Heart Rate Power Spectrum","volume":"260","author":"Randall","year":"1991","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1126\/science.6166045","article-title":"Power Spectrum Analysis of Heart Rate Fluctuation: A Quantitative Probe of Beat-to-Beat Cardiovascular Control","volume":"213","author":"Akselrod","year":"1981","journal-title":"Science"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1053\/eupc.2000.0136","article-title":"Limitations of the Use of Spectral Analysis of Heart Rate Variability for the Estimation of Cardiac Sympathetic Activity in Heart Failure","volume":"3","author":"Notarius","year":"2001","journal-title":"Europace"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.hrthm.2009.01.006","article-title":"Power Spectral Analysis of Heart Rate Variability and Autonomic Nervous System Activity Measured Directly in Healthy Dogs and Dogs with Tachycardia-Induced Heart Failure","volume":"6","author":"Piccirillo","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_62","first-page":"H215","article-title":"Low-Frequency Component of the Heart Rate Variability Spectrum: A Poor Marker of Sympathetic Activity","volume":"276","author":"Houle","year":"1999","journal-title":"Am. J. Physiol."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Billman, G.E. (2013). The LF\/HF Ratio Does Not Accurately Measure Cardiac Sympatho-Vagal Balance. Front. Physiol., 4.","DOI":"10.3389\/fphys.2013.00026"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1111\/j.1540-8167.2000.tb00005.x","article-title":"Role of the Input\/Output Relation of Sinoatrial Myocytes in Cholinergic Modulation of Heart Rate Variability","volume":"11","author":"Rocchetti","year":"2000","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/S0008-6363(01)00240-1","article-title":"Autonomic Indexes Based on the Analysis of Heart Rate Variability: A View from the Sinus Node","volume":"50","author":"Zaza","year":"2001","journal-title":"Cardiovasc. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.114.03782","article-title":"Biophysical Characterization of the Underappreciated and Important Relationship between Heart Rate Variability and Heart Rate","volume":"64","author":"Monfredi","year":"2014","journal-title":"Hypertension"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/cvr\/cvv180","article-title":"Modulation of Sympathetic Activity and Heart Rate Variability by Ivabradine","volume":"108","author":"Tobaldini","year":"2015","journal-title":"Cardiovasc. Res."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Castiglioni, P., Zaza, A., Merati, G., and Faini, A. (2025). On the Autonomic Control of Heart Rate Variability: How the Mean Heart Rate Affects Spectral and Complexity Analysis and a Way to Mitigate Its Influence. Mathematics, 13.","DOI":"10.3390\/math13182955"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"11998","DOI":"10.1038\/s41598-022-15824-0","article-title":"Reduced Heart Rate Variability Is Related to the Number of Metabolic Syndrome Components and Manifest Diabetes in the Sixth Troms\u00f8 Study 2007\u20132008","volume":"12","author":"Azulay","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.2337\/dc19-1384","article-title":"Decreased Vagal Activity and Deviation in Sympathetic Activity Precedes Development of Diabetes","volume":"43","author":"Lee","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1210\/clinem\/dgad200","article-title":"Heart Rate Variability and Incident Type 2 Diabetes in General Population","volume":"108","author":"Wang","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Im, S.I., Kim, S.J., Bae, S.H., Kim, B.J., Heo, J.H., Kwon, S.K., Cho, S.P., Shim, H., Park, J.H., and Kim, H.S. (2023). Real-Time Heart Rate Variability According to Ambulatory Glucose Profile in Patients with Diabetes Mellitus. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1249709"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.diabres.2003.10.009","article-title":"Low Heart Rate Variability Is a Risk Factor for Sudden Cardiac Death in Type 2 Diabetes","volume":"64","author":"Kataoka","year":"2004","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1007\/s00125-012-2471-y","article-title":"Resting Heart Rate and the Risk of Death and Cardiovascular Complications in Patients with Type 2 Diabetes Mellitus","volume":"55","author":"Hillis","year":"2012","journal-title":"Diabetologia"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"5147","DOI":"10.1111\/dom.16566","article-title":"Cardiovascular Autonomic Dysfunction Precedes Cardiovascular Disease and All-cause Mortality: 11-year Follow-up in the ADDITION-PRO Study","volume":"27","author":"Schaarup","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e029814","DOI":"10.1161\/JAHA.123.029814","article-title":"Cardiac Autonomic Dysfunction and Risk of Silent Myocardial Infarction Among Adults With Type 2 Diabetes","volume":"12","author":"Kaze","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e14559","DOI":"10.1111\/dme.14559","article-title":"Night-Time Heart Rate Variability Identifies High-Risk People among People with Uncomplicated Type 2 Diabetes Mellitus","volume":"38","author":"Hadad","year":"2021","journal-title":"Diabet. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0002-9149(03)00618-0","article-title":"Comparison of the Prognostic Value of RR-Interval Variability after Acute Myocardial Infarction in Patients with versus Those without Diabetes Mellitus","volume":"92","author":"Whang","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"556","DOI":"10.2337\/dc07-1615","article-title":"Prediction of Mortality Using Measures of Cardiac Autonomic Dysfunction in the Diabetic and Nondiabetic Population: The MONICA\/KORA Augsburg Cohort Study","volume":"31","author":"Ziegler","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2337\/dc16-2042","article-title":"Diabetic Neuropathy: A Position Statement by the American Diabetes Association","volume":"40","author":"Boulton","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jdiacomp.2016.03.008","article-title":"Cardiovascular Autonomic Neuropathy Associates with Nephropathy Lesions in American Indians with Type 2 Diabetes","volume":"30","author":"Wheelock","year":"2016","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1001\/jama.1994.03510350050036","article-title":"Independent Risk Factors for Atrial Fibrillation in a Population-Based Cohort: The Framingham Heart Study","volume":"271","author":"Benjamin","year":"1994","journal-title":"JAMA"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.amjcard.2011.03.004","article-title":"Meta-Analysis of Cohort and Case\u2013Control Studies of Type 2 Diabetes Mellitus and Risk of Atrial Fibrillation","volume":"108","author":"Huxley","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jacc.2019.07.020","article-title":"Atrial Fibrillation and Diabetes Mellitus: JACC Review Topic of the Week","volume":"74","author":"Wang","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Qi, W., Zhang, N., Korantzopoulos, P., Letsas, K.P., Cheng, M., Di, F., Tse, G., Liu, T., and Li, G. (2017). Serum Glycated Hemoglobin Level as a Predictor of Atrial Fibrillation: A Systematic Review with Meta-Analysis and Meta-Regression. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0170955"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3702","DOI":"10.1038\/s41598-022-07783-3","article-title":"Higher Heart Rate Variability as a Predictor of Atrial Fibrillation in Patients with Hypertension","volume":"12","author":"Kim","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.1161\/01.CIR.0000018443.44005.D8","article-title":"Autonomic Tone Variations before the Onset of Paroxysmal Atrial Fibrillation","volume":"105","author":"Bettoni","year":"2002","journal-title":"Circulation"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.ehj.2004.05.016","article-title":"Autonomic Nervous System and Paroxysmal Atrial Fibrillation: A Study Based on the Analysis of RR Interval Changes before, during and after Paroxysmal Atrial Fibrillation","volume":"25","author":"Lombardi","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jacc.2016.10.059","article-title":"Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up","volume":"69","author":"Agarwal","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/0735-1097(94)00392-4","article-title":"Relation between Heart Rate Variability and Spontaneous and Induced Ventricular Arrhythmias in Patients with Coronary Artery Disease","volume":"25","author":"Valkama","year":"1995","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1016\/S0735-1097(98)00468-9","article-title":"Autonomic Nervous System Activity and the Spontaneous Initiation of Ventricular Tachycardia","volume":"32","author":"Shusterman","year":"1998","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1111\/pace.12180","article-title":"Multipole Analysis of Heart Rate Variability as a Predictor of Imminent Ventricular Arrhythmias in ICD Patients","volume":"36","author":"Rozen","year":"2013","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Ebrahimzadeh, E., Pooyan, M., and Bijar, A. (2014). A Novel Approach to Predict Sudden Cardiac Death (SCD) Using Nonlinear and Time-Frequency Analyses from HRV Signals. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0081896"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/978-3-030-50423-6_28","article-title":"Towards Prediction of Heart Arrhythmia Onset Using Machine Learning","volume":"Volume 12140","author":"Przybylski","year":"2020","journal-title":"Computational Science\u2014ICCS 2020"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"6769","DOI":"10.1038\/s41598-020-63566-8","article-title":"Application of a Convolutional Neural Network for Predicting the Occurrence of Ventricular Tachyarrhythmia Using Heart Rate Variability Features","volume":"10","author":"Taye","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e31511","DOI":"10.1097\/MD.0000000000031511","article-title":"Heart Rate-Corrected QT Interval Prolongation Is Associated with Decreased Heart Rate Variability in Patients with Type 2 Diabetes","volume":"101","author":"Cha","year":"2022","journal-title":"Medicine"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/BF00418273","article-title":"Autonomic Neuropathy, QT Interval Lengthening, and Unexpected Deaths in Male Diabetic Patients","volume":"34","author":"Ewing","year":"1991","journal-title":"Diabetologia"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"(2022). American Diabetes Association Standards of Medical Care in Diabetes\u20142022 Abridged for Primary Care Providers. Clin. Diabetes, 40, 10\u201338.","DOI":"10.2337\/cd22-as01"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"565","DOI":"10.2147\/DMSO.S68408","article-title":"Evaluation of the Indications and Arrhythmic Patterns of 24 Hour Holter Electrocardiography among Hypertensive and Diabetic Patients Seen at OAUTHC, Ile-Ife Nigeria","volume":"7","author":"Adebayo","year":"2014","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Shaffer, F., and Ginsberg, J.P. (2017). An Overview of Heart Rate Variability Metrics and Norms. Front. Public Health, 5.","DOI":"10.3389\/fpubh.2017.00258"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/joa3.12469","article-title":"Evaluation of Heart Rate Variability Using 24-Hour Holter Electrocardiography in Hypertensive Patients","volume":"37","author":"Julario","year":"2021","journal-title":"J. Arrhythmia"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12933-025-02666-z","article-title":"Heart Rate Variability Tests for Diagnosing Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus in Advanced Stages of Kidney Disease","volume":"24","author":"Fernandes","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s13300-019-00693-0","article-title":"Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review","volume":"10","author":"Williams","year":"2019","journal-title":"Diabetes Ther."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/j.jdiacomp.2017.03.008","article-title":"Structured Lifestyle Intervention in Patients with the Metabolic Syndrome Mitigates Oxidative Stress but Fails to Improve Measures of Cardiovascular Autonomic Neuropathy","volume":"31","author":"Pennathur","year":"2017","journal-title":"J. Diabetes Complicat."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Diabetes Prevention Program (DPP) Research Group (2002). The Diabetes Prevention Program (DPP): Description of Lifestyle Intervention. Diabetes Care, 25, 2165\u20132171.","DOI":"10.2337\/diacare.25.12.2165"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1097\/HJH.0000000000001434","article-title":"Role of the Sympathetic Nervous System in Regulation of the Sodium Glucose Cotransporter 2","volume":"35","author":"Matthews","year":"2017","journal-title":"J. Hypertens."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.amjhyper.2003.11.006","article-title":"Blood Pressure and Cardiac Autonomic Nervous System in Obese Type 2 Diabetic Patients: Effect of Metformin Administration","volume":"17","author":"Manzella","year":"2004","journal-title":"Am. J. Hypertens."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2586","DOI":"10.2337\/dc18-1411","article-title":"Risk Factors for the Presence and Progression of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: ADDITION-Denmark","volume":"41","author":"Andersen","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.mayocp.2023.03.020","article-title":"Intensive Glycemic Therapy in Type 2 Diabetes Patients With Cardiac Autonomic Dysfunction: The ACCORD Trial","volume":"99","author":"Huang","year":"2024","journal-title":"Mayo Clin. Proc."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"e035788","DOI":"10.1161\/JAHA.124.035788","article-title":"Intensive Glycemic Treatment Mitigates Cardiovascular and Mortality Risk Associated With Cardiac Autonomic Neuropathy in Type 2 Diabetes","volume":"14","author":"Zhou","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"5828","DOI":"10.1038\/s41598-023-32963-0","article-title":"Investigating the Effects of Beta-Blockers on Circadian Heart Rhythm Using Heart Rate Variability in Ischemic Heart Disease with Preserved Ejection Fraction","volume":"13","author":"Saleem","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S0002-9149(02)03098-9","article-title":"Effects of Propranolol on Recovery of Heart Rate Variability Following Acute Myocardial Infarction and Relation to Outcome in the Beta-Blocker Heart Attack Trial","volume":"91","author":"Lampert","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0167-5273(01)00401-6","article-title":"Effect of Beta-Blockade on Heart Rate Variability in Decompensated Heart Failure","volume":"79","author":"Aronson","year":"2001","journal-title":"Int. J. Cardiol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"35S","DOI":"10.1016\/S0895-7061(98)00278-7","article-title":"Circadian Variation in Cardiovascular Events","volume":"12","author":"Muller","year":"1999","journal-title":"Am. J. Hypertens."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3109\/07420528.2012.674592","article-title":"A Circadian Rhythm in Heart Rate Variability Contributes to the Increased Cardiac Sympathovagal Response to Awakening in the Morning","volume":"29","author":"Boudreau","year":"2012","journal-title":"Chronobiol. Int."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.diabres.2018.07.001","article-title":"Time- and Frequency-Domain Measures of Heart Rate Variability Predict Cardiovascular Outcome in Patients with Type 2 Diabetes","volume":"143","author":"Cha","year":"2018","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1186\/s12933-025-02982-4","article-title":"Artificial Intelligence Identifies Individuals with Prediabetes Using Single-Lead Electrocardiograms","volume":"24","author":"Koga","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Huang, Y., Chen, H., Hu, D., and Wan, R. (2022). Blood Hemoglobin A1c Might Predict Adverse Differences in Heart Rate Variability in a Diabetic Population: Evidence from the Midlife in the United States (MIDUS) Study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.921287"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Chen, X., Lu, F., Zhang, J., Du, X., Xu, C., Liang, M., Chen, L., and Zhong, J. (2025). The Association between Resting Heart Rate and HbA1c-Assessed Glycemic Control in Patients with Type 2 Diabetes in Eastern China. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1478575"},{"key":"ref_120","first-page":"e80933","article-title":"Development of Enhanced Machine Learning Models for Predicting Type 2 Diabetes Mellitus Using Heart Rate Variability: A Retrospective Study","volume":"17","author":"Fengade","year":"2025","journal-title":"Cureus"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Li, K., Cardoso, C., Moctezuma-Ramirez, A., Elgalad, A., and Perin, E. (2023). Heart Rate Variability Measurement through a Smart Wearable Device: Another Breakthrough for Personal Health Monitoring?. Int. J. Environ. Res. Public Health, 20.","DOI":"10.20944\/preprints202308.0732.v1"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s40279-019-01061-5","article-title":"The Accuracy of Acquiring Heart Rate Variability from Portable Devices: A Systematic Review and Meta-Analysis","volume":"49","author":"Dobbs","year":"2019","journal-title":"Sports Med."},{"key":"ref_123","doi-asserted-by":"crossref","unstructured":"Stone, J.D., Ulman, H.K., Tran, K., Thompson, A.G., Halter, M.D., Ramadan, J.H., Stephenson, M., Finomore, V.S., Galster, S.M., and Rezai, A.R. (2021). Assessing the Accuracy of Popular Commercial Technologies That Measure Resting Heart Rate and Heart Rate Variability. Front. Sports Act. Living, 3.","DOI":"10.3389\/fspor.2021.585870"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.hrthm.2020.02.023","article-title":"Wearables in Cardiology: Here to Stay","volume":"17","author":"Dagher","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_125","unstructured":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Heart Rate Variability: Standards of Measurement, Physiological Interpretation and Clinical Use. Circulation, 93, 1043\u20131065."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/520\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:58:50Z","timestamp":1774331930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/3\/520"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,21]]},"references-count":125,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["life16030520"],"URL":"https:\/\/doi.org\/10.3390\/life16030520","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,21]]}}}