Prognostic value of resting heart rate in predicting undiagnosed diabetes in adults: Korean National Health and Nutrition Examination Survey 2008–2018

Published:September 29, 2022DOI:


      Background and aim

      Although resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset.

      Methods and results

      The Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses.
      Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77–5.77) and 3.21-times (95% CI: 2.01–5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32–1.48) and 1.28-times (95% CI: 1.19–1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m2).


      Elevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Saeedi P.
        • et al.
        Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas, 9(th) edition.
        Diabetes Res Clin Pract. 2019; 157107843
      1. Korea Statistics. Prevalence of diabetes in Korean,; 2020. [accessed 4 September 2022]

        • Shin H.-Y.
        • et al.
        Cause-of-death statistics in 2016 in the Republic of Korea.
        J Korean Med Assoc. 2018; 61
        • Cusick M.
        • et al.
        Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: early treatment diabetic retinopathy study report no. 27.
        Diabetes Care. 2005; 28: 617-625
        • Shah A.D.
        • et al.
        Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people.
        Lancet Diabetes Endocrinol. 2015; 3: 105-113
        • Ergul A.
        • et al.
        Cerebrovascular complications of diabetes: focus on stroke. Endocrine, metabolic & immune disorders-drug targets (formerly current drug targets-immune.
        Endocrine & Metabolic Disorders). 2012; 12: 148-158
        • Thiruvoipati T.
        • Kielhorn C.E.
        • Armstrong E.J.
        Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes.
        World J Diabetes. 2015; 6: 961
        • Papatheodorou K.
        • et al.
        Complications of diabetes 2017.
        Hindawi, 2018
        • Harris M.I.
        • et al.
        Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis.
        Diabetes Care. 1992; 15: 815-819
        • Harris M.I.
        • Eastman R.C.
        Early detection of undiagnosed diabetes mellitus: a US perspective.
        Diabetes/metabolism research and reviews. 2000; 16: 230-236
        • Kim B.-Y.
        • et al.
        Diabetes fact sheets in Korea, 2018: an appraisal of current status.
        Diabetes & metabolism journal. 2019; 43: 487-494
        • Mendola N.D.
        • et al.
        Prevalence of total, diagnosed, and undiagnosed diabetes among adults: United States, 2013-2016.
        US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2018
        • Lee Y.H.
        • et al.
        Undiagnosed diabetes is prevalent in younger adults and associated with a higher risk cardiometabolic profile compared to diagnosed diabetes.
        Am Heart J. 2015; 170: 760-769 e2
        • Young B.A.
        • et al.
        Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization.
        Am J Manag Care. 2008; 14: 15-23
        • Pan A.
        • et al.
        Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis.
        Lancet Diabetes Endocrinol. 2015; 3: 958-967
        • Biggs M.L.
        • et al.
        Association between adiposity in midlife and older age and risk of diabetes in older adults.
        JAMA. 2010; 303: 2504-2512
        • Patterson R.
        • et al.
        Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis.
        Eur J Epidemiol. 2018; 33: 811-829
        • Tarp J.
        • et al.
        Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: a systematic review and meta-analysis.
        Diabetologia. 2019; 62: 1129-1142
        • Sharma V.K.
        • Singh T.G.
        Chronic stress and diabetes mellitus: interwoven pathologies.
        Curr Diabetes Rev. 2020; 16: 546-556
        • Linneberg A.
        • et al.
        Effect of smoking on blood pressure and resting heart rate: a Mendelian randomization meta-analysis in the CARTA consortium.
        Circulation: Cardiovascular Genetics. 2015; 8: 832-841
        • Lindmark S.
        • et al.
        Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance.
        Obes Res. 2005; 13: 717-728
        • Alansare A.B.
        • et al.
        Associations of sedentary time with heart rate and heart rate variability in adults: a systematic review and meta-analysis of observational studies.
        Int J Environ Res Publ Health. 2021; 18: 8508
        • Gonzales T.I.
        • et al.
        Resting heart rate as a biomarker for tracking change in cardiorespiratory fitness of UK adults: the Fenland Study.
        medRxiv, 2020
        • Shalev A.Y.
        • et al.
        A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.
        Arch Gen Psychiatr. 1998; 55: 553-559
        • Lee D.H.
        • et al.
        Resting heart rate and risk of type 2 diabetes: a prospective cohort study and meta-analysis.
        Diabetes/metabolism research and reviews. 2019; 35: e3095
        • Kim G.
        • et al.
        Increase in resting heart rate over 2 years predicts incidence of diabetes: a 10-year prospective study.
        Diabetes Metab. 2017; 43: 25-32
        • Li Y.Q.
        • et al.
        Resting heart rate as a marker for identifying the risk of undiagnosed type 2 diabetes mellitus: a cross-sectional survey.
        BMC Publ Health. 2014; 14: 1052
      2. Korea National Health And Nutrition Survey Examine., Survey method of examine in Korea national health and nutrituion examin; Accessed 29 October 2021.

        • Oh J.Y.
        • et al.
        Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form.
        Journal of the Korean Academy of Family Medicine. 2007; 28: 532-541
        • Lee J.
        • et al.
        Development of the Korean global physical activity questionnaire: reliability and validity study.
        Global health promotion. 2020; 27: 44-55
        • Aune D.
        • ó Hartaigh B.
        • Vatten L.
        Resting heart rate and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of cohort studies.
        Nutr Metabol Cardiovasc Dis. 2015; 25: 526-534
        • Young C.N.
        • et al.
        Insulin enhances the gain of arterial baroreflex control of muscle sympathetic nerve activity in humans.
        J Physiol. 2010; 588: 3593-3603
        • Anderson E.A.
        • et al.
        Hyperinsulinemia produces both sympathetic neural activation and vasodilation in normal humans.
        J Clin Invest. 1991; 87: 2246-2252
        • Baron A.D.
        • et al.
        Reduced postprandial skeletal muscle blood flow contributes to glucose intolerance in human obesity∗.
        J Clin Endocrinol Metab. 1990; 70: 1525-1533