Acute hypoglycemia and risk of cardiac arrhythmias in insulin-treated type 2 diabetes and controls
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Acute hypoglycemia and risk of cardiac arrhythmias in insulin-treated type 2 diabetes and controls. / Andersen, Andreas; Bagger, Jonatan I.; Baldassarre, Maria Pa; Christensen, Mikkel B; Abelin, Kirsten U; Faber, Jens; Pedersen-Bjerregaard, Ulrik; Holst, Jens J; Lindhardt, Tommi B; Gislason, Gunnar Hilmar; Knop, Filip K; Vilsbøll, Tina.
I: European Journal of Endocrinology, Bind 185, Nr. 2, 2021, s. 343-353.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Acute hypoglycemia and risk of cardiac arrhythmias in insulin-treated type 2 diabetes and controls
AU - Andersen, Andreas
AU - Bagger, Jonatan I.
AU - Baldassarre, Maria Pa
AU - Christensen, Mikkel B
AU - Abelin, Kirsten U
AU - Faber, Jens
AU - Pedersen-Bjerregaard, Ulrik
AU - Holst, Jens J
AU - Lindhardt, Tommi B
AU - Gislason, Gunnar Hilmar
AU - Knop, Filip K
AU - Vilsbøll, Tina
PY - 2021
Y1 - 2021
N2 - OBJECTIVE: Hypoglycemia is associated with increased risk of cardiovascular disease including cardiac arrhythmias. We investigated the effect of hypoglycemia in the setting of acute glycemic fluctuations on cardiac rhythm and cardiac repolarization in insulin-treated patients with type 2 diabetes compared with matched controls without diabetes.DESIGN: A non-randomised, mechanistic intervention study Methods. Insulin-treated patients with type 2 diabetes (n=21, [mean±SD] age 62.8±6.5 years, BMI 29.0±4.2 kg/m2, HbA1c 6.8±0.5% [51.0±5.4 mmol/mol]) and matched controls (n=21, age 62.2±8.3 years, BMI 29.2±3.5 kg/m2, HbA1c 5.3±0.3% [34.3±3.3 mmol/mol]) underwent a sequential hyperglycemic and hypoglycemic clamp with three steady-states of plasma glucose: 1) fasting plasma glucose, 2) hyperglycemia (fasting plasma glucose+10 mmol/L) and 3) hyperinsulinemic hypoglycemia (plasma glucose<3.0 mmol/L). Participants underwent continuous ECG monitoring and blood samples for counterregulatory hormones and plasma potassium were obtained.RESULTS: Both groups experienced progressively increasing heart rate corrected QT (Fridericia's formula)) interval prolongations during hypoglycemia ([∆mean (95% CI)] 31 ms [16, 45] and 39 ms [24, 53] in the group of patients with type 2 diabetes and controls, respectively) with similar increases from baseline at the end of the hypoglycemic phase (P=0.43). The incidence of ventricular premature beats increased significantly in both groups during hypoglycemia (P=0.033 and P<0.0001, respectively). One patient with type 2 diabetes developed atrial fibrillation during recovery from hypoglycemia.CONCLUSIONS: In insulin-treated patients with type 2 diabetes and controls without diabetes, hypoglycemia causes clinically significant and similar increases in cardiac repolarization that might increase vulnerability for serious cardiac arrythmias and sudden cardiac death.
AB - OBJECTIVE: Hypoglycemia is associated with increased risk of cardiovascular disease including cardiac arrhythmias. We investigated the effect of hypoglycemia in the setting of acute glycemic fluctuations on cardiac rhythm and cardiac repolarization in insulin-treated patients with type 2 diabetes compared with matched controls without diabetes.DESIGN: A non-randomised, mechanistic intervention study Methods. Insulin-treated patients with type 2 diabetes (n=21, [mean±SD] age 62.8±6.5 years, BMI 29.0±4.2 kg/m2, HbA1c 6.8±0.5% [51.0±5.4 mmol/mol]) and matched controls (n=21, age 62.2±8.3 years, BMI 29.2±3.5 kg/m2, HbA1c 5.3±0.3% [34.3±3.3 mmol/mol]) underwent a sequential hyperglycemic and hypoglycemic clamp with three steady-states of plasma glucose: 1) fasting plasma glucose, 2) hyperglycemia (fasting plasma glucose+10 mmol/L) and 3) hyperinsulinemic hypoglycemia (plasma glucose<3.0 mmol/L). Participants underwent continuous ECG monitoring and blood samples for counterregulatory hormones and plasma potassium were obtained.RESULTS: Both groups experienced progressively increasing heart rate corrected QT (Fridericia's formula)) interval prolongations during hypoglycemia ([∆mean (95% CI)] 31 ms [16, 45] and 39 ms [24, 53] in the group of patients with type 2 diabetes and controls, respectively) with similar increases from baseline at the end of the hypoglycemic phase (P=0.43). The incidence of ventricular premature beats increased significantly in both groups during hypoglycemia (P=0.033 and P<0.0001, respectively). One patient with type 2 diabetes developed atrial fibrillation during recovery from hypoglycemia.CONCLUSIONS: In insulin-treated patients with type 2 diabetes and controls without diabetes, hypoglycemia causes clinically significant and similar increases in cardiac repolarization that might increase vulnerability for serious cardiac arrythmias and sudden cardiac death.
U2 - 10.1530/EJE-21-0232
DO - 10.1530/EJE-21-0232
M3 - Journal article
C2 - 34085953
VL - 185
SP - 343
EP - 353
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
SN - 0804-4643
IS - 2
ER -
ID: 272642463