Document Detail


Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk.
MedLine Citation:
PMID:  24757202     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Recent trials of intensive glycemic control suggest a possible link between hypoglycemia and excess cardiovascular mortality in patients with type 2 diabetes. Hypoglycemia might cause arrhythmias through effects on cardiac repolarization and changes in cardiac autonomic activity. Our aim was to study the risk of arrhythmias during spontaneous hypoglycemia in type 2 diabetic patients with cardiovascular risk. Twenty-five insulin-treated patients with type 2 diabetes and a history of cardiovascular disease or two or more risk factors underwent simultaneous continuous interstitial glucose and ambulatory electrocardiogram monitoring. Frequency of arrhythmias, heart rate variability, and markers of cardiac repolarization were compared between hypoglycemia and euglycemia and between hyperglycemia and euglycemia matched for time of day. There were 134 h of recording at hypoglycemia, 65 h at hyperglycemia, and 1,258 h at euglycemia. Bradycardia and atrial and ventricular ectopic counts were significantly higher during nocturnal hypoglycemia compared with euglycemia. Arrhythmias were more frequent during nocturnal versus daytime hypoglycemia. Excessive compensatory vagal activation after the counterregulatory phase may account for bradycardia and associated arrhythmias. QT intervals, corrected for heart rate, >500 ms and abnormal T-wave morphology were observed during hypoglycemia in some participants. Hypoglycemia, frequently asymptomatic and prolonged, may increase the risk of arrhythmias in patients with type 2 diabetes and high cardiovascular risk. This is a plausible mechanism that could contribute to increased cardiovascular mortality during intensive glycemic therapy.
Authors:
Elaine Chow; Alan Bernjak; Scott Williams; Robert A Fawdry; Steve Hibbert; Jenny Freeman; Paul J Sheridan; Simon R Heller
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetes     Volume:  63     ISSN:  1939-327X     ISO Abbreviation:  Diabetes     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-04-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372763     Medline TA:  Diabetes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1738-47     Citation Subset:  AIM; IM    
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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