Insulin Dosing Is Associated With Cardiac Sympathetic Predominance Independent of Glycemic Profiles in Type 1 Diabetes Under Free-Living Conditions

by sugaradmin



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.

Article Highlights
  • 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.





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