Previous evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease, for which persons with diabetes are at increased risk. We examined the association between heart rate and levels of glycemia in a nationally representative sample of U.S. adults.

This study included 27,602 adults age ≥20 years from the 2011-2014 National Health and Nutrition Examination Surveys. Levels of glycemia were defined as: diagnosed diabetes (self-report); undiagnosed diabetes [fasting plasma glucose (FPG) ≥126mg/dL or A1c ≥6.5%]; prediabetes (FPG 100-125mg/dL or A1c 5.7%-6.4%); normoglycemia (FPG <100mg/dL and A1c <5.7%). Predictive margins regression was used to determine mean HR by participant characteristics and glycemic status; and among those with diagnosed diabetes, by participant characteristics and A1c level. Mean HR was adjusted for age, sex, race/ethnicity, education, poverty income ratio, health insurance, smoking status, body mass index, history of cardiovascular disease, kidney disease, and antihypertensive medications; models by A1c level were additionally adjusted for oral antidiabetic medications. Mean HR was significantly higher for those with diagnosed and undiagnosed diabetes compared to those with normoglycemia (74 bpm vs. 72 bpm, p<0.05, for both). In the fully adjusted model, mean HR remained significantly higher for those with diagnosed (76 bpm) and undiagnosed diabetes (75 bpm) compared to those with normoglycemia (71 bpm, p<0.05 for both). Among persons with diagnosed diabetes, there was a positive association between HR and glycemic levels as measured by A1c (72 bpm, 75 bpm, 77 bpm, and 81 bpm for A1c <7.0%, 7.0%- <9.0%, 9.0%- <11.0%, and A1c ≥11.0%, respectively, p<0.001), and this association remained after adjustment for risk factors.

In conclusion, mean HR was higher among persons with diabetes and increased glycemia, which may reflect subtle autonomic and/or myocardial dysfunction among those with diabetes.


S. Casagrande: None. C.C. Cowie: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen Inc., Fresenius SE & Co. KGaA, General Electric, Johnson & Johnson, Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc. J.M. Sosenko: None. K.R. Mizokami-Stout: None. A.J. Boulton: None. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association.


National Institute of Diabetes and Digestive and Kidney Diseases

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at