Feasibility of combining heart rate variability and electrochemical skin conductance as screening and severity evaluation of cardiovascular autonomic neuropathy in type 2 diabetes

J Diabetes Investig. 2021 Sep;12(9):1671-1679. doi: 10.1111/jdi.13518. Epub 2021 Mar 13.


Aims/introduction: Clinical studies show that either heart rate variability (HRV) or electrochemical skin conductance (ESC) alone can serve as a simple and objective method for screening cardiovascular autonomic neuropathy (CAN). We tested the hypothesis that combining these two quantitative approaches can not only reinforce accuracy in CAN screening but also provide a better estimate of CAN severity in patients with type 2 diabetes (T2DM) who had already had CAN in outpatient clinics.

Materials and methods: Each patient received a complete battery of cardiovascular autonomic reflex tests (CARTs), with ESC measured by SUDOSCAN, time domain of HRV measured by standard deviation of all normal RR intervals (SDNN) and frequency domain of HRV (low frequency [LF], high frequency [HF], and LF/HF ratio), and peripheral blood studies for vascular risk factors. Severity of CAN was measured by CAN score.

Results: The 90 T2DM patients included 50 males and 40 females. Those with more severe CAN had lower values in feet ESC (P = 0.023) and SDNN (P < 0.0001). Multiple linear regression analysis also showed that feet ESC and SDNN value (P = 0.003 and P < 0.0001) were significantly associated with CAN score. Combining SDNN and feet ESC also can increase the diagnostic accuracy of CAN with respective to sensitivity and specificity by using receiver operating characteristic analysis.

Conclusions: Combining the results of SDNN and feet ESC can not only assess, but also quantitatively reflect the progress or improvement of autonomic nerve function (including sympathetic and parasympathetic activity) in patients with T2DM.

Keywords: Cardiovascular autonomic neuropathy; Electrochemical skin conductance; Heart rate variability.

MeSH terms

  • Aged
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / pathology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Neuropathies / diagnosis*
  • Diabetic Neuropathies / etiology
  • Diabetic Neuropathies / pathology
  • Electrochemical Techniques / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Galvanic Skin Response*
  • Heart Rate*
  • Humans
  • Male
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index*