Cardiac Effects of Sulfonylurea-Related Hypoglycemia.

Autor: Middleton TL; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia timothy.middleton@sswahs.nsw.gov.au.; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia., Wong J; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia., Molyneaux L; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia., Brooks BA; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; School of Nursing, University of Sydney, Sydney, New South Wales, Australia., Yue DK; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia., Twigg SM; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; Department of Medicine, University of Sydney, Sydney, New South Wales, Australia., Wu T; Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Diabetes care [Diabetes Care] 2017 May; Vol. 40 (5), pp. 663-670. Date of Electronic Publication: 2017 Feb 21.
DOI: 10.2337/dc16-1972
Abstrakt: Objective: To determine the effect of sulfonylurea-related hypoglycemia on cardiac repolarization and ectopy in the setting of well-controlled type 2 diabetes.
Research Design and Methods: Thirty subjects with sulfonylurea-treated type 2 diabetes underwent 48 h of concurrent continuous glucose monitoring and ambulatory electrocardiography. Ventricular repolarization (QTc) and QT dynamicity were analyzed during periods of hypoglycemia (<3.5 mmol/L for >20 min) and compared with periods of euglycemia and hyperglycemia combined. Cardiac ectopy rates during hypoglycemia were compared with ectopy rates when blood glucose was 4-10 mmol/L.
Results: Mean HbA 1c was 6.9% (52 mmol/mol). Hypoglycemia was detected in 9 of 30 subjects (30%); episodes were typically nocturnal (67%) and asymptomatic (73%). Hypoglycemia-associated QTc prolongation was seen in five of nine subjects with a large variation in individual response. Higher QT dynamicity, a poor prognostic factor in cardiac disease, was seen in subjects who experienced hypoglycemia compared with subjects who did not (0.193 vs. 0.159 for the nocturnal period; P = 0.01). This finding persisted after the hypoglycemic event. The rates of ventricular and supraventricular ectopy demonstrated a nonsignificant trend toward an increase during hypoglycemia (median rate ratio 1.58 and 1.33, respectively). Similar, nonsignificant results were observed in a separate insulin-treated cohort.
Conclusions: Hypoglycemia, often unrecognized, is a frequent finding in well-controlled sulfonylurea-treated type 2 diabetes. It is associated with the novel finding of increased QT dynamicity and QTc prolongation in some individuals. Our findings suggest sulfonylurea-related hypoglycemia can have detrimental cardiovascular sequelae. Similar effects are also seen in the setting of insulin therapy.
(© 2017 by the American Diabetes Association.)
Databáze: MEDLINE
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