P-469: Neuro-metabolic decoupling in type 2 diabetes: synchronized collapse of executive inhibitory control and vagal autonomic tone — a dual-domain psychophysiological analysis
T Mutalikdesai, N S AnandAbstract
Introduction
Chronic hyperglycemia dismantles both prefrontal executive braking and parasympathetic autonomic regulation, yet the functional synchrony of this dual collapse and its graded relationship with glycemic burden remain uncharacterized, leaving a critical diagnostic gap in early-onset disease.
Objectives
To quantify the concurrent deterioration of central inhibitory control and vagal autonomic tone in T2DM, and establish dose-response relationships between metabolic load and neuro-cognitive dysregulation.
Methods
Cross-sectional comparative study: 50 T2DM patients (ages 30–60, ADA criteria) versus 50 age/sex/BMI-matched normoglycemic controls. Autonomic profiling: short-term HRV (SDNN, RMSSD; LF, HF, LF/HF ratio). Neuro-cognitive battery: stop-signal task (SSRT; inhibitory control), Eriksen flanker task (conflict resolution), visual dot-probe (threat-bias), psychomotor vigilance task (processing speed), and continuous performance test (sustained attention). HbA1c and disease duration indexed metabolic burden. Independent t-tests, Pearson correlations, and regression modeling (p<0.05).
Results
T2DM patients showed significantly prolonged SSRT (p<0.01), indicating prefrontal inhibitory failure. This was structurally mirrored by attenuated RMSSD and HF-HRV, confirming simultaneous vagal brake collapse. HbA1c and disease duration independently predicted elevated threat-bias and greater flanker conflict cost, establishing a direct metabolic dose-response on affective-cognitive regulation.
Conclusions
T2DM produces a coherent neuro-metabolic decoupling syndrome wherein central executive and autonomic inhibitory systems erode in tandem. These adult data provide the longitudinal disease projection critically relevant to ISPAD: youth-onset T2DM patients silently accumulate this neuro-cognitive deficit from diagnosis. HRV-indexed vagal tone and SSRT constitute first-tier neuro-protective biomarkers warranting immediate integration into pediatric diabetes screening protocols.