Heart Rate Variability and Diabetic Neuropathy: A Systematic Review of Current Research and Implications for Clinical Practice

• Puneet vedprakash aggarwal,*  
• Anita Verma

Abstract

Diabetic neuropathy (DN), a common complication of diabetes mellitus, is associated with significant morbidity and mortality, primarily due to its impact on autonomic dysfunction. One of the most widely used measures of autonomic function is heart rate variability (HRV), which reflects the balance between the sympathetic and parasympathetic branches of the autonomic nervous system. This systematic review aims to synthesize the current evidence on the relationship between HRV and diabetic neuropathy, focusing on pathophysiological mechanisms, clinical implications, and potential therapeutic interventions. A comprehensive search of PubMed, Google Scholar, and Embase was conducted for studies published up to 2023. Keywords included "heart rate variability," "diabetic neuropathy," and "autonomic dysfunction," “T2DM”. Studies were included if they assessed HRV in diabetic patients with neuropathy and explored its relationship with disease severity or cardiovascular risk. Data were extracted on study design, participant characteristics, HRV measurement techniques, and key findings. A meta-analysis was conducted as per PRISMA guidelines. A total of 10 studies met the inclusion criteria. Findings consistently indicated that patients with diabetic neuropathy show significantly reduced HRV compared to those without neuropathy. Reduced HRV was strongly associated with increased severity of neuropathy and cardiovascular autonomic dysfunction. Kaneko, K., et al. (2013) [9]. Studies also demonstrated a potential predictive value of HRV for the progression of diabetic neuropathy. Moreover, interventions such as exercise and glycaemic control were found to improve HRV and, by extension, autonomic function in diabetic patients. Reduced HRV is a reliable marker of autonomic dysfunction in diabetic neuropathy and is associated with an increased risk of cardiovascular events. Clinically, HRV measurement may serve as a useful tool for monitoring the progression of diabetic neuropathy and assessing the effectiveness of interventions. Further randomized controlled trials are needed to establish the causal relationship between HRV and diabetic neuropathy and to explore the therapeutic potential of interventions aimed at improving HRV.

Keywords

Heart rate variability, Diabetic neuropathy, Autonomic dysfunction, Type 2 Diabetes mellitus (T2DM)