Prospective investigation of autonomic nervous system function and the development of type 2 diabetes - The Atherosclerosis Risk in Communities study, 1987-1998

Background - Autonomic nervous system (ANS) dysfunction has been correlated with fasting insulin and glucose, independent of clinically diagnosed diabetes. We tested whether men and women ( aged 45 to 64 years) from the Atherosclerosis Risk In Communities study (n = 8185) with ANS dysfunction, estimated by high heart rate (HR) and low HR variability (HRV), were at increased risk for developing type 2 diabetes. Methods and Results - Supine HR and HRV indices were measured for 2 minutes at baseline; indices were divided into quartiles for analyses. From 1987 to 1998 ( mean follow-up 8.3 years), there were 1063 cases of incident diabetes. The relative risk (RR) of developing diabetes for participants with low-frequency (LF) power (0.04 to 0.15 Hz) HRV in the lowest quartile (<7.7 ms(2)) compared with the highest quartile (>= 38.9 ms(2)) was 1.2 (95% CI 1.0-1.4) after adjustment for age, race, sex, study center, education, alcohol drinking, current smoking, prevalent coronary heart disease, physical activity, and body mass index. Participants in the uppermost (>72.7 bpm) versus the lowest (less than or equal to60.1 bpm) quartile of HR had a 60% increased risk ( 95% CI 33%-92%) of developing diabetes. Results were similar when the sample was restricted to participants with normal fasting glucose ( glucose <6.1 mmol/L) at baseline ( n = 7192) or when adjusted for baseline glucose ( HR quartile 4 versus quartile 1, RR = 1.4, 95% CI 1.2-1.7). Conclusions - These findings suggest that ANS dysfunction may be associated with the development of diabetes in healthy adults.