OBJECTIVE The autonomic nervous system (ANS) innervates pancreatic endocrine cells, muscle, and liver, all of which participate in glucose metabolism. We tested whether measures of cardiovascular ANS function are independently associated with incident diabetes and annual change in fasting glucose (FG) levels as well as with insulin secretion and insulin sensitivity in older adults without diabetes. RESEARCH DESIGN AND METHODS Heart rate (HR) and measures of HR variability (HRV) were derived from 24-h electrocardiographic monitoring. Blood pressure, seated and standing, was measured. Cox proportional hazards models and linear mixed models were used to analyze the associations between HRV, HR, and orthostatic hypotension (SBP >20 mmHg decline) and incident diabetes or longitudinal FG change. RESULTS The mean annual unadjusted FG change was 1 mg/dL. Higher detrended fluctuation analyses (DFA) values, averaged over 4–11 (DFA1) or 12–20 beats (DFA2)—reflecting greater versus less organization of beat-to-beat intervals—were associated with less FG increase over time (per 1-SD increment: DFA1: −0.49 mg/dL/year [−0.96, −0.03]; DFA2: −0.55 mg/dL/year [−1.02, −0.09]). In mutually adjusted analyses, higher SD of the N-N interval (SDNN) was associated with less FG increase over time (per 1-SD increment: SDNN: −0.62 mg/dL/year [−1.22, −0.03]). Higher values of DFA1, DFA2, and SDNN were each associated with greater insulin secretion and insulin sensitivity but not with incident diabetes. We observed no association of HR or orthostatic hypotension with diabetes or FG change. CONCLUSIONS Specific measures of cardiac autonomic function are prospectively related to FG level changes and insulin secretion and action.

中文翻译：

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心血管自主功能、心率和体位性低血压测量值与血糖异常的关联：心血管健康研究

目的 自主神经系统 (ANS) 支配胰腺内分泌细胞、肌肉和肝脏，所有这些细胞都参与葡萄糖代谢。我们测试了心血管 ANS 功能的测量是否与糖尿病发生率、空腹血糖 (FG) 水平的年度变化以及无糖尿病老年人的胰岛素分泌和胰岛素敏感性独立相关。研究设计和方法 心率 (HR) 和心率变异性 (HRV) 测量值来自 24 小时心电图监测。测量坐位和站立时的血压。使用Cox比例风险模型和线性混合模型来分析HRV、HR和直立性低血压(SBP下降＞20mmHg)与事件糖尿病或纵向FG变化之间的关联。结果 年平均未调整 FG 变化为 1 mg/dL。较高的去趋势波动分析 (DFA) 值（平均 4-11 次 (DFA1) 或 12-20 次心跳 (DFA2)）——反映了心跳间隔的组织性更强与更少——与随时间推移 FG 增加较少相关（每 1 -SD增量：DFA1：-0.49 mg/dL/年[-0.96，-0.03]；DFA2：-0.55 mg/dL/年[-1.02，-0.09]）。在相互调整的分析中，较高的 NN 间隔 (SDNN) SD 与随时间推移 FG 增加较少相关（每 1-SD 增量：SDNN：−0.62 mg/dL/年 [−1.22，−0.03]）。DFA1、DFA2 和 SDNN 的较高值均与较高的胰岛素分泌和胰岛素敏感性相关，但与糖尿病发病率无关。我们观察到 HR 或体位性低血压与糖尿病或 FG 变化没有关联。结论 心脏自主神经功能的具体测量与 FG 水平变化以及胰岛素分泌和作用前瞻性相关。