PSYCHOVEGETATIVE DISORDERS AND HEART RATE VARIABILITY IN MEN WITH TYPE 2 DIABETES MELLITUS AND THYROID DYSFUNCTION IN COMORBIDITY CONDITIONS

Abstract

Background. Despite active research on autonomic dysfunction in type 2 diabetes and thyroid diseases, there are limited data on the relationship between HRV and the psychoemotional state in men with multimorbidity, including chronic gastritis and cardiohepatobiliary disorders.

Purpose. To study the peculiarities of autonomic regulation and psychoemotional state in men with type 2 diabetes and thyroid dysfunction depending on the structure of comorbid somatic disease against the background of chronic gastritis.

Materials and methods. The study included 106 men aged 35–50 years with verified chronic gastritis in combination with type 2 diabetes, hypo- or hyperthyroidism, and varying degrees of hepatobiliary and cardiovascular comorbidity. HRV was assessed using SDNN, RMSSD, and LF/HF indices with Kubios HRV Premium software. The psycho-emotional state was evaluated using the validated scales HADS, BDI-II, and DASS-21. Statistical analysis was performed using one-way analysis of variance (ANOVA) with Tukey’s post hoc test; differences were considered statistically significant at p ˂ 0.05. The unequal sizes of the clinical groups were taken into account during the analysis.

Results. The most unfavorable psychovegetative profile was found in men with type 2 diabetes in combination with chronic gastritis and cardiohepatobiliary pathology. In this group, a marked reduction in HRV indices was noted (SDNN ≈ 32 ms, RMSSD ≈ 15 ms, LF/HF > 4; p < 0.001), indicating pronounced autonomic imbalance. Depression scores on the BDI-II corresponded to a clinically relevant level and were accompanied by a large effect size (d ≥ 1.0).

In hypothyroidism, a decrease in SDNN and RMSSD (37 ms and 24 ms, respectively) was observed, suggesting general suppression of autonomic regulation. In patients of this group, depressive manifestations predominated in the psychoemotional profile.

In hyperthyroidism, a marked increase in the LF/HF index to 3.7 was observed, along with a decrease in RMSSD to 20 ms. The psychoemotional profile was characterized by increased levels of anxiety and stress.

Conclusion. Type 2 diabetes and thyroid dysfunction in men, when accompanied by a broader spectrum of comorbid somatic conditions, were associated with lower indices of autonomic regulation and more pronounced psychoemotional changes. The lowest HRV parameters and the highest levels of psychoemotional disturbances were observed in patients with a combination of type 2 diabetes, cardiohepatobiliary pathology, and chronic gastritis. The obtained data suggest that a combined assessment of HRV and psychometric indicators may be useful for improving risk stratification in patients with endocrine disorders.