Background and aims: to identify heart rate variability (HRV) and blood pressure (BP) in patients with type 1 diabetes depending on the duration of disease and glycemic control.Materials and methods: 43 patients were examined. All patients were divided into 2 groups according to the level of НвА1с: group 1 (n=21) with НвА1с ≤ 7.5% and group 2 (n=22) with НвА1с > of 7.5%. All patients underwent daily monitoring of electrocardiogram Holter and ambulatory BP monitoring within 24 hours in parallel with long term monitoring of blood glucose.Results: Hyppoglycemia is characterized by significant decrease root mean square difference between adjacent RR intervals (RMSSD) (r = −0.531; p = 0.003) and number of consecutive RR intervals, the difference between them is more than 50 ms expressed as a percentage of total number of RR-intervals (pNN50%) (r = the −0.503; p = 0.005) and increase of Low Frequency/High Frequency Ratio (LF/HF) (r = 0552; p = 0.002). Patients with hypoglycemia had significantly higher daily diastolic pressure area index (DPAI24) (p = 0.016), and daily diastolic pressure time index DPTI24 (p = 0.025).Conclusion: our findings demonstrate the need to reduce the frequency of hypoglycemia episodes in patients with T1DM.
Актуальность. Сахарный диабет (СД) признан Всемирной организацией здравоохранения неинфекционной эпидемией XXI века. Сердечно-сосудистая патология является основной причиной смерти этих пациентов. Цель исследования: изучить показатели вариабельности сердечного ритма (ВСР) у больных СД 2-го типа в зависимости от степени компенсации, а также их динамику после коррекции сахароснижающей терапии. Материалы и методы. Обследовано 53 пациента с СД 2-го типа и 10 практически здоровых людей контрольной группы. Лабораторное исследование включало определение С-пептида, гликированного гемоглобина (HbA1c), креатинина крови и микроальбумина в утренней порции мочи. Всем обследуемым проводилось длительное мониторирование гликемии параллельно с электрокардиографией по Холтеру в течение 24 часов. Пациенты были разделены на две группы по уровню НbА1с: группа 1 (n = 23) с НbА1с ≤ 7 % и группа 2 (n = 30) с НbА1с > 7 %. Группы были разделены на подгруппы по отсутствию (а) или наличию (б) гипогликемии. Через 6 месяцев после модификации сахароснижающей терапии проводилось повторное обследование пациентов в том же объеме. Результаты. Группы и подгруппы больных СД 2-го типа существенно не отличались между собой по показателям ВСР (p > 0,05) и имели достоверное снижение показателей SDNN сутки, pNN50% сутки, VLF сутки, высокочастотный спектр (HF) ВРС сутки в сравнении с контрольной группой (р < 0,05). Суточные показатели общей мощности спектра (TP) существенно не отличались от контроля только в 1а подгруппе (р > 0,05). Значения низкочастотного спектра (LF) ВРС сутки были достоверно ниже по сравнению с контролем только при анализе всей основной группы больных СД 2-го типа. Показатель LF/HF сутки был достоверно выше контроля во всех подгруппах обеих групп (р < 0,05). Выводы. Пациенты с СД 2-го типа имели достоверно более низкие показатели ВСР, которые преимущественно касались SDNN, TP и VLF, HF и LF/HF. Через 6 месяцев после модификации сахароснижающей терапии получено достоверное увеличение практически всех показателей ВСР, кроме LF. Наибольшая динамика касалась повышения показателей pNN50% сутки (+50 %), pNN50% день (+50 %), RMSSD день (+43,5 %), RMSSD сутки (+28,6 %), HF (+133,1 % — сутки, +172,2 % — день, +57,5 % — ночь) и снижение отношения LF/HF (–42,9 % — сутки, –46,2 % — день, –32,7 % — ночь) (p < 0,05). Полученные результаты наглядно демонстрируют восстановление вагосимпатического баланса сердечно-сосудистой системы под влиянием компенсации углеводного обмена.
Diabetes mellitus is recognized as a new non-infectious «epidemic of the XXI century» due to its steady increase in morbidity and a number of medical and social problems. These problems are associated with disability and mortality of patients resulted from the development of chronic complications of the disease. Hyperglycemia plays a major role in the development of diabetic complications. Diabetic microangiopathies predetermine the course and prognosis of the disease. HbA1c level and glucose variability are the complementary characteristics of glucose control. The aim of the study was to develop a mathematical model for predicting the development of diabetic microangiopathy in patients with diabetes type 1 by using continuous glucose monitoring system (CGMS). 62 patients (aged 18–45 years) with type 1 diabetes mellitus were examined. Clinical laboratory examination included: assessment of the of HbA1c level, C-peptide level, levels of blood creatinine and albuminuria. Patients were divided into groups: group 1 had HbA1c≤7.0% (n = 18), group 2 had HbA1c> 7.0% (n = 44). Long-term monitoring of blood glucose levels was conducted with using the CGMS system during 6 days. Maximum blood glucose level, minimum blood glucose level and the difference of maximum and minimum blood glucose levels were accounted. The mathematical equation was obtained by using the simple linear regression analysis. This mathematical equation shows relationship between the level of albuminuria and the difference between maximum and minimum blood glucose levels. It can be used to predict the progression of diabetic nephropathy in patients with type 1 diabetes. We suggested the method for prognosticating the development and progression of diabetic microangiopathy (on an example of diabetic nephropathy) in patients with diabetes mellitus type 1 that does not require special software. This calculation may be performed using self-monitoring of blood glucose in clinical practice.
The aim: to study the features of daily profile and circadian rhythm of blood pressure (BP) in groups of patients with type 1 diabetes mellitus (T1DM), depending on glycemic control. Materials and methods: 63 patients with T1DM, age: 18-45 years without hypertension were examined. Patients were divided into groups: Group 1 — HbA1c≤7.0% (n=21), Group 2 — HbA1c>7.0% (n=42). 10 sex- and agematched healthy controls were included. Results: Patients with T1DM had a significantly higher pulsatile blood pressure (PBP) per night, higher daily systolic blood pressure (SBP) variability, compared with healthy controls, and significantly higher daily SBP area index (SPAI24), daily SBP time index (SPTI24), daily diastolic blood pressure (DBP) area index (DPAI24), daily DBP time index (DPTI24). The double product (DP) was higher in patients with T1DM in the daytime and within 24 hours compared to control (p=0.002) and (p=0.001) respectively. Pathological profiles of daily blood pressure were found. In group 1, according to the dipping in SBP 28.57% of patients were non-dippers, 4.76% were extreme dippers. In group 2, the non-dipper profile had 33.33%, the reverse dipper had 2.38%, and extreme dipper had 11.90% of patients. According to the dipping in DBP: in group 1 33.33% were non-dippers, and 9.53% were extreme dippers. In group 2 non-dippers — 19.04%, extreme dippers — 2.38%, extreme dippers — 38.10%. HbA1c directly correlates with: (DPAI24) (ρ=0,301; р=0,014), DPAI night (ρ=0,292; р=0,010), DPTI24 (ρ=0.292; p=0.012), DPTI night (ρ=0.268; p=0.018). Conclusions. The daily blood pressure profile in patients with T1DM without arterial hypertension is characterized by insufficient decrease in BP at night, an increase in the average daily DBP, PBP, as well as DPAI24, DPTI24, DP and the variability of the average daily SBP. Poor glucose control led to led to an increase in hemodynamic load. It is the risk factor cardiovascular complications in patients with T1DM.
Background and Aims: To study the correlation of heart rate variability (HRV) in patients with type 1 diabetes mellitus (T1DM) depending on glucose control and hypoglycemia. Materials and Methods: The study involved 87 patients with T1D, including 45 men (52%), women - 42 (48%). The average age of patients - 26,6±1,48 years, disease duration 11,6±1,42 years, BMI 23,2 ± 0,63 kg/m2. All patients used basic-bolus insulin therapy with daily dose of Units 45±2,26. All patients were conducted with Continuous Glucose Monitoring System (CGMS) and 24-Hour Holter Monitoring (HM) in same time. Echocardiography was used to exclude organic pathology of the heart. Patients were divided to groups according to HbA1c. Group 1 had HbA1c?7,5%; group 2 had HbA1c>7,5%, and subgroups: A-without hypoglycemia, B-with hypoglycemia. Results. Groups did not differ in the frequency of hypoglycemia. Calculation of results depending on the duration T1DM showed an increase LF/HF (r=0,472; p<0,05). Groups differed significantly according to the following frequency characteristics of heart rate such as VLF, LF, HF (p<0,05). The groups did not differ in other factors. In Group 2B as compared to 2A identified decrease such time-domain indicators of HRV: RMSSD 22,8 ms (15,0; 36,0) vs. 32,6 ms (27,0; 43,0); pNN50 daily 3.50% (1.0; 10.0) vs. 8.50% (6,00-13,50) and daily frequency characteristics HRV: HF 380,0 ms2 (149,0; 715,0) to 719.0 ms2 (475.0, 1153.0) and increased LF/HF 4,35 (4,10; 6,50) vs. 3.30 (2.30; 4.30). All findings are significant (p<0,05). A similar pattern was observed in patients in 1st group. Conclusions: HRV is lower in patients with bed glucose control (HbA1c>7,5%). The most reliable criteria for assessing changes in HRV are in patients with T1DM are RMSSD, LF, HF and LF/HF are. Hypoglycemia is the most significant factor that reduces the HRV. Disclosure K. Moshenets: None. N. Pertseva: None.
За даними International Diabetes Federation, у світі налічується 415 млн дорослого населення, що страждає від цукрового діабету (ЦД). При тенденції, що зберігається, до 2040 року кількість хворих досягне 642 млн людей, з яких на ЦД 1-го типу припадає від 7 до 17 %. Хоча ЦД 1-го типу трапляється рідше, ніж ЦД 2-го типу, у світі його щорічний приріст становить приблизно 3 % [1]. Збільшення тривалості життя хворих на ЦД вплинуло на структуру їх смертності. Дане захворювання призводить до інвалідності в молодому та середньому віці внаслідок розвитку і прогресуван-ня його ускладнень (переважно мікроангіопатія та нефропатія) [2-4]. Метаболічні зміни, що формуються, сприяють розвитку серцево-судинної недостатності в працездатної категорії пацієнтів. Це становить як медичну, так і соціальну проблему [5]. Смертність від серцево-судинних захворювань у пацієнтів із ЦД у 2-3 рази вища, ніж серед населення загалом [4, 6, 7]. Згідно з рекомендаціями Американської діабетичної асоціації (АДА) до клінічних проявів ураження серцево-судинної системи при ЦД 1-го типу відносять тахікардію спокою, що супроводжується подовженням інтервалу QT, фіксований серцевий
Background. An increase in the prevalence of type 2 diabetes mellitus (DM) is accompanied by an increase in the number of patients with severe chronic complications. Diabetic kidney disease (DKD) is the leading cause of death in these patients after cardiovascular diseases. The purpose was to predict the progression of DKD in patients with type 2 diabetes mellitus depending on the glucose variability (GV) measured by continuous glucose monitoring. Materials and methods. We examined 53 type 2 DM patients aged 57.0 (51.0; 64.0) years with an average disease duration of 9.0 (6.0; 13.0) years. The laboratory examination included determination of glycated hemoglobin, blood creatinine, albuminuria (AU), glomerular filtration rate (GFR) according to CKD-EPI equation. GV was measured by iPro2 GMS system. The maximum and minimum blood glucose levels and standard deviation (SD) of glycemia were considered. The role of GV in predicting DKD progression has been established using stepwise multiple regression analysis. Results. DKD was detected in 41.51 % of patients. In regression analysis, we created a linear multiple regression equation to describe the dependence of AU on the GV, F = 10.39 (p < 0.001). The variability of AU by 36.7 % is due to the minimum level of glycemia and SD of glycemia — multiple correlation coefficient R is 0.6372, the coefficient of determination R2 is 0.4060, adjusted R2 is 0.3670. Partial coefficient of correlation between AU and SD of glycemia, r = 0.25 (p = 0.027); between AU and the minimum blood glucose level, r = 0.31 (p = 0.005). Conclusions. According to the results of correlation analysis, a significant effect of GV, as well as the value of minimum blood glucose level on AU was established. It is statistically proved that high fluctuations of glycemia (SD) should be considered as a factor predicting the progression of DKD in type 2 DM patients. Using regression analysis, a mathematical model of DKD progression in type 2 DM patients was developed based on GV parameters.
The aim of the study: to assess the impact of glycemic variability on the duration of QTc interval in patients with diabetes mellitus type 2. 68 patients with type 2 diabetes mellitus (DM) and glycosylated hemoglobin (HbA1c) level ≤10% were examined. Of them – 37 (54.4%) men and 31 (45.6%) women. The average age – 46.0 (43.0; 54.0) years, the duration of DM type 2 – 7.0 (5.0; 9.0) years. Patients were divided into 2 groups according to HbA1c level: group 1 (n=31) with HbA1c <7% and group 2 (n=37) with HbA1c ≥7%. The control group consisted of 10 practically healthy people, compared by gender and age. The duration of the QTc interval was calculated automatically by Bazett's formula during 24-hour Holter electrocardiogram (ECG) recordings. Additionally, the percentage of cases of exceeding the QTc threshold over 450 ms (QTc>450) was also calculated. Simultaneously with 24-hour Holter monitoring, the continuous glucose monitoring was performed, using iPro2 system (Medtronic MiniMed, USA). The maximum value of glycemia (Gmax), the minimum value of glycemia (Gmin), as well as indicators of glycemia variability (GV) were analyzed: standard deviation of mean glycemia (SD) and glycemia range (GR). The duration of daily QTc and the value of QTc >450 in patients with type 2 DM were significantly greater compared with the control group (p<0.05) and did not depend on the HbA1c level. In type 2 DM patients without recorded hypoglycemic episodes, the characteristics of QTc did not differ from the results of the control group (p>0.05). At the time of the hypoglycemic episode, the QTc duration in patients with type 2 DM significantly increased compared with the average daily value of QTc in the same patients – 487 (466; 519.5) ms against 436.5 (431; 452) ms (p<0.001). A strong correlation between QTc duration and the presence of hypoglycemia was determined (rs=0.78; p=0.023). QTc duration also correlated with GR (rs=0.23; p=0.016) and SD (rs=0.21; p=0.021). Therefore, it was found that in patients with type 2 diabetes, the prolongation of QTc duration is associated with high glycemic fluctuations and hypoglycemia (p<0.05) regardless of the HbA1c level.
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