Preserved cardiac vagal tone is associated with nocturnal glycaemic stability
6 affiliations
- 1Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- 2Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- 3Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- 4The Autonomic Laboratory, William Harvey Heart Centre, Queen Mary University of London, London, UK
- 5Steno Diabetes Center North Denmark, Aalborg University Hospital, Gistrup, Denmark
- 6Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Abstract
Aims/hypothesis: Parasympathetic dysfunction is implicated in the pathogenesis of type 2 diabetes; however, its relationship with glucose regulation remains poorly understood. Thus, the aim of this study was to investigate the association between central parasympathetic function assessed as cardiac vagal tone (CVT) and continuous glucose monitoring (CGM) outcomes during sleep in individuals with and without type 2 diabetes.
Methods: This cross-sectional study included 20 individuals without diabetes and 40 individuals with type 2 diabetes, aged 45–75 years. They were home-monitored for 72 h, comprising nocturnal recordings of ECG-derived CVT measured using the ProCVT SmartSheet and Dexcom G6 CGM blinded to participants. Mean CVT was dichotomised into ‘normal’ CVT (≥5.0) and ‘poor’ CVT (<5.0). Only individuals for whom ≥70% of the total recording was classified as valid noise-free ECG data were analysed (N=50).
Results: Across all individuals, higher nocturnal CVT predicted a lower coefficient of variation in glucose (β=−0.8, p=0.030) and greater time in tight range (β=5.2, p=0.001). In individuals without diabetes, higher CVT was associated with reduced risk of hyperglycaemia (−10.2%, p=0.015), time above range (−11.8%, p=0.015) and time in moderate hyperglycaemia (−11.8%, p=0.015), and increased glucose mobility (β=0.014, p=0.029). In all individuals, poor CVT at the 15 min segment level was associated with a 1.9% increase in glucose in the subsequent period (p=0.049).
Conclusions/interpretation: Preserved CVT, indicating normal central parasympathetic tone, is associated with a stable and dynamically regulated glucose profile with reduced adverse glucose mobilisation during sleep. This may have implications for glycaemic regulation in individuals with autonomic neuropathy.
Graphical Abstract:
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BibTeX
@article{poulsen2026preserved,
title = {{Preserved cardiac vagal tone is associated with nocturnal glycaemic stability}},
author = {Maria Bitsch Poulsen and Simon Lebech Cichosz and Peter Julu and Johan Røikjer and Asbjørn Mohr Drewes and Christina Brock},
journal = {Diabetologia},
year = {2026},
month = sep,
doi = {10.1007/s00125-026-06844-w},
url = {https://doi.org/10.1007/s00125-026-06844-w},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preserved cardiac vagal tone is associated with nocturnal glycaemic stability
AU - Maria Bitsch Poulsen
AU - Simon Lebech Cichosz
AU - Peter Julu
AU - Johan Røikjer
AU - Asbjørn Mohr Drewes
AU - Christina Brock
PY - 2026
DA - 2026/09/09
JO - Diabetologia
DO - 10.1007/s00125-026-06844-w
UR - https://doi.org/10.1007/s00125-026-06844-w
AB - Aims/hypothesis: Parasympathetic dysfunction is implicated in the pathogenesis of type 2 diabetes; however, its relationship with glucose regulation remains poorly understood. Thus, the aim of this study was to investigate the association between central parasympathetic function assessed as cardiac vagal tone (CVT) and continuous glucose monitoring (CGM) outcomes during sleep in individuals with and without type 2 diabetes. Methods: This cross-sectional study included 20 individuals without diabetes and 40 individuals with type 2 diabetes, aged 45–75 years. They were home-monitored for 72 h, comprising nocturnal recordings of ECG-derived CVT measured using the ProCVT SmartSheet and Dexcom G6 CGM blinded to participants. Mean CVT was dichotomised into ‘normal’ CVT (≥5.0) and ‘poor’ CVT (<5.0). Only individuals for whom ≥70% of the total recording was classified as valid noise-free ECG data were analysed (N=50). Results: Across all individuals, higher nocturnal CVT predicted a lower coefficient of variation in glucose (β=−0.8, p=0.030) and greater time in tight range (β=5.2, p=0.001). In individuals without diabetes, higher CVT was associated with reduced risk of hyperglycaemia (−10.2%, p=0.015), time above range (−11.8%, p=0.015) and time in moderate hyperglycaemia (−11.8%, p=0.015), and increased glucose mobility (β=0.014, p=0.029). In all individuals, poor CVT at the 15 min segment level was associated with a 1.9% increase in glucose in the subsequent period (p=0.049). Conclusions/interpretation: Preserved CVT, indicating normal central parasympathetic tone, is associated with a stable and dynamically regulated glucose profile with reduced adverse glucose mobilisation during sleep. This may have implications for glycaemic regulation in individuals with autonomic neuropathy. Graphical Abstract:
SN - 0012-186X
SN - 1432-0428
ER -