Adynamic response to cold pain reflects dysautonomia in type 1 diabetes and polyneuropathy

Thomas Arendt Nielsen, Søren Lundbye-Christensen, Yoanna Krasimirova Dimitrova, Sam Riahi, Birgitte Brock, Asbjørn Mohr Drewes, Christina Brock*

*Corresponding author for this work

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Abstract

Cardiac autonomic neuropathy (CAN), widely assessed by heart rate variability (HRV), is a common complication of long-term diabetes. We hypothesized that HRV dynamics during tonic cold pain in individuals with type 1 diabetes mellitus (T1DM) could potentially demask CAN. Forty-eight individuals with long-term T1DM and distal symmetrical polyneuropathy and 21 healthy controls were included. HRV measures were retrieved from 24-h electrocardiograms. Moreover, ultra-short-term HRV recordings were used to assess the dynamic response to the immersion of the hand into 2 °C cold water for 120 s. Compared to healthy, the T1DM group had expectedly lower 24-h HRV measures for most components (p < 0.01), indicating dysautonomia. In the T1DM group, exposure to cold pain caused diminished sympathetic (p < 0.001) and adynamic parasympathetic (p < 0.01) HRV responses. Furthermore, compared to healthy, cold pain exposure caused lower parasympathetic (RMSSD: 4% vs. 20%; p = 0.002) and sympathetic responses (LF: 11% vs. 73%; p = 0.044) in the T1MD group. QRISK3-scores are negatively correlated with HRV measures in 24-h and ultra-short-term recordings. In T1DM, an attenuated sympathovagal response was shown as convincingly adynamic parasympathetic responses and diminished sympathetic adaptability, causing chronometric heart rhythm and rigid neurocardiac regulation threatening homeostasis. The findings associate with an increased risk of cardiovascular disease, emphasizing clinical relevance.

Original languageEnglish
Article number11318
JournalScientific Reports
Volume13
Issue number1
Number of pages12
ISSN2045-2322
DOIs
Publication statusPublished - 2023

Bibliographical note

Funding Information:
Novo Nordisk Scandinavia AS, The Innovation Fund Denmark, Individuals, Disease and Society, Copenhagen, Denmark (Grant No. 10-092786), and Empowering Industry and Research (EIR) Northern Jutland supported this trial. C.B. received funding from the Talent Program at Aalborg University.

Publisher Copyright:
© 2023, The Author(s).

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