Noninvasive Detection of Acute Hyperglycemia Using Signal from Wearable ECG Sensors Considering Individual HRV Response Delays to Glucose

Abstract

Noninvasive blood glucose monitoring is crucial for detecting early dysglycemia, yet continuous glucose monitors remain invasive and costly. Electrocardiogram (ECG) and its derived heart rate variability (HRV) measure may offer a noninvasive indicator of autonomic and cardiac responses associated with acute changes in glucose. In this study, 30 adults underwent a 75 g oral glucose tolerance test with concurrent ECG Holter and interstitial glucose monitoring. From these recordings, HRV and ECG features were extracted. A deep learning classifier with HRV and ECG was then trained to detect hyperglycemia (glucose ≥ 180 mg/dL). Cross-correlation analysis confirmed a significant association between HRV and glucose (Pearson r ~0.65, p < 0.05) when aligning each participant’s data according to individual response delays. The model achieved high classification performance under rigorous temporal validation (accuracy ~89%, area under the receiver operating characteristic curve ~0.89). Saliency analyses revealed that the classifier’s decisions focus on distinct ECG waveform transitions and key HRV features linked to glucose-induced autonomic changes. Overall, acute hyperglycemia elicited discernible changes in HRV and cardiac conduction, supporting the feasibility of this physiologically grounded approach for detecting the acute hyperglycemic phase under controlled conditions. This method holds promise for real-time implementation in wearable devices, enabling early diabetes risk screening.