Exploring the Impact of Type 2 Diabetes on Autonomic Nervous System Function: Insights from Resting States and Active Orthostatic Testing

Abstract

Background:
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder associated with significant impairments in autonomic nervous system (ANS) function. Autonomic modulation, critical for maintaining cardiovascular homeostasis, is particularly affected, leading to dysregulation in response to physiological stressors such as postural changes. Understanding these alterations is essential for early identification and management of cardiovascular autonomic neuropathy (CAN) in individuals with T2DM.

Objectives:
This study aims to evaluate the impact of T2DM on autonomic modulation at rest and during the active orthostatic test (AOT), focusing on heart rate variability (HRV) and blood pressure responses.

Methods:
A retrospective study was conducted with 100 participants, including 50 adults with T2DM and 50 age-matched healthy controls. HRV parameters were analyzed at rest and during AOT using spectral domain methods. Blood pressure responses were monitored to assess autonomic reactivity. Statistical comparisons between groups were performed to evaluate differences in autonomic modulation.

Results:
Individuals with T2DM exhibited significantly reduced HRV parameters, including lower high-frequency (HF) power, indicating diminished parasympathetic activity. During AOT, T2DM participants showed impaired systolic blood pressure recovery and exaggerated sympathetic dominance, reflected in higher low-frequency (LF) power and LF/HF ratio. These findings suggest autonomic dysfunction characterized by parasympathetic withdrawal and unopposed sympathetic activation in response to postural changes.

Conclusions:
T2DM profoundly impacts autonomic modulation, with significant impairments in resting and reactive autonomic function. Early detection of these alterations using HRV and AOT can facilitate timely interventions to mitigate cardiovascular risk and improve patient outcomes.