Effect Of Short-Term Intensive Insulin Pump Therapy On Heart Rate Variability In Elderly Patients With Type 2 Diabetes Mellitus

ObjectiveThe prevalence rate of diabetes in people over 60 years old is close to 20%.Diabetic cardiac autonomic neuropathy(CAN)is one of the easily neglected complications of diabetes.Cardiac autonomic nervous imbalance will increase the risk of cardiovascular events in these patients.Heart rate variability(HRV)is a commonly used clinical index to reflect cardiac autonomic nervous function.In this study,wearable accompanying monitoring system was used to accurately,reliably and continuously collect and analyze a variety of physiological data,including HRV,to explore whether HRV changes in elderly patients with type 2 diabetes after short-term insulin pump treatment,so as to understand the relationship between blood glucose control and CAN.At the same time,the main factors affecting the decrease of HRV in elderly patients with type 2 diabetes mellitus were discussed.MethodsA total of 146elderly patients with type 2 diabetes who were hospitalized in the endocrinology department of our hospital from October 2020 to December 2021 were collected.HRV was collected by wearing a monitoring system.Paired t-test was used to compare the changes of HRV before and after insulin pump intensive treatment.In order to explore the difference of long-term blood glucose control and the effect of short-term intensive insulin pump therapy on HRV,the patients were divided into two groups according to glycosylated hemoglobin(HbA1c):good blood glucose control group(HbAlc<7%)and poor blood glucose control group(HbAlc≥7%).The changes of HRV in the two groups were observed after short-term insulin pump treatment.In order to further explore the influencing factors of HRV decrease in elderly patients with type 2 diabetes mellitus,according to the standard deviation of all normal sinus RR intervals(SDNN),the subjects were divided into normal HRV group(SDNNN≥102ms,n=74)and HRV decreased group(SDNN<102ms,n=72).The general and biochemical data of the two groups were compared,and binary Logistic regression analysis was used to screen the possible influencing factors of HRV decrease in patients with type 2 diabetes.Results1.After short-term intensive insulin pump therapy,there was no significant difference in HRV parameters of SDNN,RMSSD,PNN50,VLF,LF,HF,TP and LF/HF in elderly patients with type 2 diabetes(P>0.05).2.After short-term intensive insulin pump therapy,the levels of SDNN,RMSSD,PNN50 and LF/HF in elderly patients with type 2 diabetes mellitus with glycosylated hemoglobin<7%were significantly higher than those before treatment(P<0.05).3.After short-term intensive insulin pump therapy,the HRV parameters SDNN,RMSSD,PNN50,VLF,LF,HF,TP and LF/HF of elderly patients with type 2 diabetes mellitus with glycosylated hemoglobin≥ 7%had no significant difference compared with those before treatment(P>0.05).4.Age,course of diabetes,body mass index(BMI),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),HbAlc were positively correlated with the decrease of HRV(P<0.05).Conclusion1.In elderly patients with type 2 diabetes with good blood glucose control,HRV increased after short-term intensive insulin pump treatment,which improved diabetic cardiac autonomic neuropathy.2.Elderly patients with type 2 diabetes with poor blood glucose control had no significant effect on HRV after short-term intensive insulin pump therapy.3.Age,course of diabetes,BMI,TC,LDL-C and HbA1c are the possible influencing factors of HRV decrease in elderly patients with type 2 diabetes.