Evaluating the Schematic Assessment of Impact of Glycemic Control on Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus, A systematic Review and Meta-Analysis

Background: Glycemic control is essential component in cardiac autonomic neuropathy. This meta-analysis and systematic review aimed to determine the effect of interventional measures on the cardiac autonomic function of patients with type 2 diabetes mellitus (T2DM). Methodology: An extensive search in PubMed, Scopus, Web of Science, and Google Scholar until November 2025 was conducted. The included studies' reference lists were also screened in order to come up with more relevant articles. The randomized controlled trials, the prospective cohort studies, and the observational studies that measure cardiac autonomic functioning in patients with T2DM were covered. Data regarding study design, population size, nature of intervention (e.g., slow deep breathing, percutaneous coronary intervention), autonomic outcomes, and the follow-up period were collected using a standardized form. The risk of bias was also measured by adapting an in vivo study tool, and the degree of certainty of evidence was gauged through the GRADE method. Results: 12 studies passed the inclusion criteria. The meta-analysis of both primary outcomes; E: I ratio and Valsalva ratio showed no statistically significant improvements, respectively. There was a high heterogeneity (I2 = 95-98%), which could probably be explained by the variation in the nature of patients, types of interventions, and protocols of measurement. The rigor of findings was ensured by subgroup and sensitivity analysis. Conclusion: T2DM patients have mixed effects on cardiac autonomic functioning in terms of interventions. Non-pharmacological and multimodal approaches have the potential to be of value, particularly in optimal glycemic control, yet standardized trials are needed to offer certain directions.