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    Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE

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    Author
    Khandoker, AH; Al-Angari, HM; Khalaf, K; Lee, S; Almahmeed, W; Al Safar, HS; Jelinek, HF
    Date
    2017-01-20
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    KHANDOKER, AHSAN
    Affiliation
    Electrical and Electronic Engineering
    Metadata
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    Document Type
    Journal Article
    Citations
    Khandoker, A. H., Al-Angari, H. M., Khalaf, K., Lee, S., Almahmeed, W., Al Safar, H. S. & Jelinek, H. F. (2017). Association of Diabetes Related Complications with Heart Rate Variability among a Diabetic Population in the UAE. PLOS ONE, 12 (1), https://doi.org/10.1371/journal.pone.0168584.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/258114
    DOI
    10.1371/journal.pone.0168584
    Abstract
    Microvascular, macrovascular and neurological complications are the key causes of morbidity and mortality among type II diabetes mellitus (T2DM) patients. The aim of this study was to investigate the alterations of cardiac autonomic function of diabetic patients in relation to three types of diabetes-related complications. ECG recordings were collected and analyzed from 169 T2DM patients in supine position who were diagnosed with nephropathy (n = 55), peripheral neuropathy (n = 64) and retinopathy (n = 106) at two hospitals in the UAE. Comparison between combinations of patients with complications and a control diabetic group (CONT) with no complication (n = 34) was performed using time, frequency and multi-lag entropy measures of heart rate variability (HRV). The results show that these measures decreased significantly (p<0.05) depending on the presence and type of diabetic complications. Entropy, (median, 1st- 3rd interquartile range) for the group combining all complications (1.74,1.37-2.09) was significantly lower than the corresponding values for the CONT group (1.77, 1.39-2.24) with lag-1 for sequential beat-to-beat changes. Odds ratios (OR) from the entropy analysis further demonstrated a significantly higher association with the combination of retinopathy and peripheral neuropathy versus CONT (OR: 1.42 at lag 8) and an even OR for the combination of retinopathy and nephropathy (OR: 2.46 at lag 8) compared to the other groups with complications. Also, the OR of low frequency power to high frequency power ratio (LF/HF) showed a higher association with these diabetic-related complications compared to CONT, especially for the patient group combining all complications (OR: 4.92). This study confirms that the type of microvascular or peripheral neuropathy complication present in T2DM patients have different effects on heart rate entropy, implying disorders of multi-organ connectivity are directly associated with autonomic nervous system dysfunction. Clinical practice may benefit from including multi-lag entropy for cardiac rhythm analysis in conjunction with traditional screening methods in patients with diabetic complications to ensure better preventive and treatment outcomes in the Emirati Arab population.

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