Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study
Abstract Background Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease and mortality. Using a long-term monitoring approach, we investigated the association between episodes of hypoglycemia, glycemic v...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-021-01425-0 |
| _version_ | 1819097912505794560 |
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| author | Andreas Andersen Jonatan I. Bagger Samuel K. Sørensen Maria P. A. Baldassarre Ulrik Pedersen-Bjergaard Julie L. Forman Gunnar Gislason Tommi B. Lindhardt Filip K. Knop Tina Vilsbøll |
| author_facet | Andreas Andersen Jonatan I. Bagger Samuel K. Sørensen Maria P. A. Baldassarre Ulrik Pedersen-Bjergaard Julie L. Forman Gunnar Gislason Tommi B. Lindhardt Filip K. Knop Tina Vilsbøll |
| author_sort | Andreas Andersen |
| collection | DOAJ |
| description | Abstract Background Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease and mortality. Using a long-term monitoring approach, we investigated the association between episodes of hypoglycemia, glycemic variability and cardiac arrhythmias in a real-life setting. Methods Insulin-treated patients with T2D (N = 21, [mean ± SD] age 66.8 ± 9.6 years, BMI 30.1 ± 4.5 kg/m2, HbA1c 6.8 ± 0.4% [51.0 ± 4.8 mmol/mol]) were included for a one-year observational study. Patients were monitored with continuous glucose monitoring ([mean ± SD] 118 ± 6 days) and an implantable cardiac monitor (ICM) during the study period. Results Time spend in hypoglycemia was higher during nighttime than during daytime ([median and interquartile range] 0.7% [0.7–2.7] vs. 0.4% [0.2–0.8]). The ICMs detected 724 episodes of potentially clinically significant arrhythmias in 12 (57%) participants, with atrial fibrillation and pauses accounting for 99% of the episodes. No association between hypoglycemia and cardiac arrhythmia was found during daytime. During nighttime, subject-specific hourly incidence of cardiac arrhythmias tended to increase with the occurrence of hypoglycemia (incident rate ratio [IRR] 1.70 [95% CI 0.36–8.01]) but only slightly with increasing time in hypoglycemia (IRR 1.04 [95% CI 0.89–1.22] per 5 min). Subject-specific incidence of cardiac arrhythmias during nighttime increased with increasing glycemic variability as estimated by coefficient of variation whereas it decreased during daytime (IRR 1.33 [95% CI 1.05–1.67] and IRR 0.77 [95% CI 0.59–0.99] per 5% absolute increase, respectively). Conclusions Cardiac arrhythmias were common in insulin-treated patients with T2D and were associated with glycemic variability, whereas arrhythmias were not strongly associated with hypoglycemia. Trial registration: NCT03150030, ClinicalTrials.gov, registered May 11, 2017. https://clinicaltrials.gov/ct2/show/NCT03150030 |
| first_indexed | 2024-12-22T00:22:38Z |
| format | Article |
| id | doaj.art-fd3a7bdef6d242cd9140f4168ec4b003 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-22T00:22:38Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-fd3a7bdef6d242cd9140f4168ec4b0032022-12-21T18:45:08ZengBMCCardiovascular Diabetology1475-28402021-12-0120111010.1186/s12933-021-01425-0Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational studyAndreas Andersen0Jonatan I. Bagger1Samuel K. Sørensen2Maria P. A. Baldassarre3Ulrik Pedersen-Bjergaard4Julie L. Forman5Gunnar Gislason6Tommi B. Lindhardt7Filip K. Knop8Tina Vilsbøll9Clinical Research, Steno Diabetes Center Copenhagen, University of CopenhagenClinical Research, Steno Diabetes Center Copenhagen, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenCenter for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of CopenhagenDeparment of Biomedical Sciences, Faculty of Health and Medical Sciences, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenDepartment of Cardiology, Herlev and Gentofte Hospital, University of CopenhagenClinical Research, Steno Diabetes Center Copenhagen, University of CopenhagenClinical Research, Steno Diabetes Center Copenhagen, University of CopenhagenAbstract Background Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease and mortality. Using a long-term monitoring approach, we investigated the association between episodes of hypoglycemia, glycemic variability and cardiac arrhythmias in a real-life setting. Methods Insulin-treated patients with T2D (N = 21, [mean ± SD] age 66.8 ± 9.6 years, BMI 30.1 ± 4.5 kg/m2, HbA1c 6.8 ± 0.4% [51.0 ± 4.8 mmol/mol]) were included for a one-year observational study. Patients were monitored with continuous glucose monitoring ([mean ± SD] 118 ± 6 days) and an implantable cardiac monitor (ICM) during the study period. Results Time spend in hypoglycemia was higher during nighttime than during daytime ([median and interquartile range] 0.7% [0.7–2.7] vs. 0.4% [0.2–0.8]). The ICMs detected 724 episodes of potentially clinically significant arrhythmias in 12 (57%) participants, with atrial fibrillation and pauses accounting for 99% of the episodes. No association between hypoglycemia and cardiac arrhythmia was found during daytime. During nighttime, subject-specific hourly incidence of cardiac arrhythmias tended to increase with the occurrence of hypoglycemia (incident rate ratio [IRR] 1.70 [95% CI 0.36–8.01]) but only slightly with increasing time in hypoglycemia (IRR 1.04 [95% CI 0.89–1.22] per 5 min). Subject-specific incidence of cardiac arrhythmias during nighttime increased with increasing glycemic variability as estimated by coefficient of variation whereas it decreased during daytime (IRR 1.33 [95% CI 1.05–1.67] and IRR 0.77 [95% CI 0.59–0.99] per 5% absolute increase, respectively). Conclusions Cardiac arrhythmias were common in insulin-treated patients with T2D and were associated with glycemic variability, whereas arrhythmias were not strongly associated with hypoglycemia. Trial registration: NCT03150030, ClinicalTrials.gov, registered May 11, 2017. https://clinicaltrials.gov/ct2/show/NCT03150030https://doi.org/10.1186/s12933-021-01425-0Type 2 diabetesInsulin treatmentHypoglycemiaGlycemic variabilityCardiac arrhythmias |
| spellingShingle | Andreas Andersen Jonatan I. Bagger Samuel K. Sørensen Maria P. A. Baldassarre Ulrik Pedersen-Bjergaard Julie L. Forman Gunnar Gislason Tommi B. Lindhardt Filip K. Knop Tina Vilsbøll Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study Cardiovascular Diabetology Type 2 diabetes Insulin treatment Hypoglycemia Glycemic variability Cardiac arrhythmias |
| title | Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study |
| title_full | Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study |
| title_fullStr | Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study |
| title_full_unstemmed | Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study |
| title_short | Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study |
| title_sort | associations of hypoglycemia glycemic variability and risk of cardiac arrhythmias in insulin treated patients with type 2 diabetes a prospective observational study |
| topic | Type 2 diabetes Insulin treatment Hypoglycemia Glycemic variability Cardiac arrhythmias |
| url | https://doi.org/10.1186/s12933-021-01425-0 |
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