Chen Xiangyu, Lu Feng, Zhang Jie, Du Xiaofu, Xu Chunxiao, Liang Mingbin, Chen Lijin, Zhong Jieming
Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
Front Endocrinol (Lausanne). 2025 Jun 16;16:1478575. doi: 10.3389/fendo.2025.1478575. eCollection 2025.
This study aimed to explore the association between resting heart rate (RHR) and HbA1c-assessed glycemic control in patients with type 2 diabetes mellitus (T2DM).
This cross-sectional study was conducted in Zhejiang Province, Eastern China, from March to November 2018. The association between RHR and inadequate glycemic control was analyzed using multivariable logistic regression and restricted cubic spline models. Additionally, a generalized additive model was employed to examine the association between RHR and HbA1c levels.
A total of 1,756 patients with T2DM were included in this study. The prevalence of inadequate glycemic control was 48.92% in this population. After adjusting for age, sex, educational level, body mass index, hypertension, abnormal total cholesterol, abnormal triglyceride, cigarette smoking, and duration of diabetes, when compared to the first quintile of RHR (< 70 beats per minute [bpm]), patients in the second quintile (70-75 bpm), third quintile (76-80 bpm), fourth quintile (81-87 bpm), and fifth quintile (≥88 bpm) had increased risks of inadequate glycemic control, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were: 1.11 (0.82-1.49), 1.50 (1.10-2.06), 1.70 (1.25-2.31), and 2.14 (1.56-2.94), respectively. When RHR was treated as a continuous variable, each 10 bpm increase was associated with a 27% higher risk of inadequate glycemic control (OR: 1.27; 95% CI: 1.16-1.39). Moreover, HbA1c levels were positively correlated with increasing RHR in this population (Spearman correlation coefficient=0.15, P<0.001). Subgroup analyses confirmed that the association between elevated RHR and inadequate glycemic control persisted across all key demographic strata (all p < 0.05). Notably, BMI significantly modified this relationship (p for interaction < 0.05), with a more pronounced effect observed in individuals with higher BMI.
Elevated RHR is associated with inadequate glycemic control and higher HbA1c levels. Our findings suggest a potential bidirectional relationship between RHR and glycemic control in T2DM patients. These results may contribute to individualized clinical management and inform targeted public health strategies aimed at early identification and intervention in high-risk T2DM populations.
本研究旨在探讨2型糖尿病（T2DM）患者静息心率（RHR）与糖化血红蛋白（HbA1c）评估的血糖控制之间的关联。
本横断面研究于2018年3月至11月在中国东部的浙江省进行。使用多变量逻辑回归和受限立方样条模型分析RHR与血糖控制不佳之间的关联。此外，采用广义相加模型检验RHR与HbA1c水平之间的关联。
本研究共纳入1756例T2DM患者。该人群中血糖控制不佳的患病率为48.92%。在调整年龄、性别、教育水平、体重指数、高血压、总胆固醇异常、甘油三酯异常、吸烟和糖尿病病程后，与RHR的第一个五分位数（<70次/分钟[bpm]）相比，第二个五分位数（70 - 75 bpm）、第三个五分位数（76 - 80 bpm）、第四个五分位数（81 - 87 bpm）和第五个五分位数（≥88 bpm）的患者血糖控制不佳的风险增加，调整后的比值比（OR）及其95%置信区间（CI）分别为：1.11（0.82 - 1.49）、1.50（1.10 - 2.06）、1.70（1.25 - 2.31）和2.14（1.56 - 2.94）。当将RHR视为连续变量时，每增加10 bpm与血糖控制不佳风险高27%相关（OR：1.27；95% CI：1.16 - 1.39）。此外，该人群中HbA1c水平与RHR升高呈正相关（Spearman相关系数 = 0.15，P < 0.001）。亚组分析证实，RHR升高与血糖控制不佳之间的关联在所有关键人口统计学分层中均持续存在（所有p < 0.05）。值得注意的是，体重指数显著改变了这种关系（交互作用p < 0.05），在体重指数较高的个体中观察到更明显的影响。
RHR升高与血糖控制不佳和更高的HbA1c水平相关。我们的研究结果表明T2DM患者的RHR与血糖控制之间可能存在双向关系。这些结果可能有助于个性化临床管理，并为旨在早期识别和干预高危T2DM人群的针对性公共卫生策略提供信息。
