Autonomic dysfunction and insulin resistance in type 2 diabetes mellitus with hypoglycemia unawareness: an observational study.

Purpose: To evaluate the association between hypoglycemia unawareness, cardiac autonomic function, and insulin resistance in individuals with type2 diabetes, and explore potential correlations between autonomic dysfunction and metabolic parameters. Methods: = 25). Standardized cardiovascular autonomic function tests (AFTs) and short-term heart rate variability (HRV) analyses were performed. Autonomic dysfunction was graded using Ewing's, Bellavere's, and All India Institute of Medical Sciences AFT Lab criteria. Results: = 0.021), but no significant difference in homeostatic model assessment for insulin resistance was observed. Serum insulin levels showed negative correlations with sympathetic function measures. Conclusion: Hypoglycemia unawareness in T2DM is associated with combined sympathetic and parasympathetic dysfunction and reduced HRV, consistent with a hypoglycemia-associated autonomic failure cycle. Routine autonomic assessment may aid in early detection, risk stratification, and prevention of adverse cardiovascular outcomes in this high-risk subgroup.