Acute changes in plasma glucose increases left ventricular systolic function in insulin‐treated patients with type 2 diabetes and controls

Abstract

Aims We aimed to evaluate the effect of acute hyperglycaemia and hypoglycaemia on cardiac function in patients with type 2 diabetes (T2D) and a control group. Materials and methods In a nonrandomized interventional study, insulin‐treated patients with T2D (N = 21, mean ± SD age 62.8 ± 6.5 years, body mass index [BMI] 29.0 ± 4.2 kg/m2, glycated haemoglobin [HbA1c] 51.0 ± 5.4 mmol/mol [6.8 ± 0.5%]) and matched controls (N = 21, mean ± SD age 62.2 ± 8.3 years, BMI 29.2 ± 3.5 kg/m2, HbA1c 34.3 ± 3.3 mmol/L [5.3 ± 0.3%]) underwent one experimental day with plasma glucose (PG) clamped at three different 30‐minute steady‐state levels: (1) fasting plasma glucose (FPG); (2) hyperglycaemia (FPG + 10 mmol/L); and (3) hyperinsulinaemic hypoglycaemia (PG <3.0 mmol/L). Cardiac function was evaluated during each steady state by echocardiography. Results Acute hyperglycaemia increased left ventricular (LV) ejection fraction from baseline in patients with T2D (mean [95% confidence interval] 4.5 percentage points [1.1; 7.9]) but not in controls (2.0 percentage points [−1.4; 5.4]). Mitral annular peak systolic velocity (s′) increased during hyperglycaemia in both patients and controls (0.4 m/s [0.2;0.6] and 0.6 m/s [0.4; 0.8], respectively), whereas global longitudinal strain rate only increased in the controls (−0.05 s−1 [−0.12; 0.02] and −0.11 s−1 [−0.18; −0.03], respectively). All measures of LV systolic function increased markedly during hypoglycaemia (P <0.01 for all). No interaction between group and PG level on cardiac function was observed. Conclusions Acute hyperglycaemia and hypoglycaemia increase LV systolic function, with no difference between patients with T2D and controls. Standardization of PG may improve reproducibility when evaluating LV systolic function in patients with T2D.

Evaluation of Cardiac Arrhythmias in Diabetic Patients Admitted to Intensive Care Unit with Acute Hyperglycemic Syndromes: Prospective One Year Study

“…In support of the present result, another study by Aygün et al [8] found increase in heart rate during acute hyperglycemic crisis more than heart rate after recovery. Additionally, the study of Andersen et al [14] supported the same result of the faster heart rate at the time of acute hyperglycemic syndromes.…”

Hypoglycaemia and rebound hyperglycaemia increase left ventricular systolic function in patients with type 1 diabetes

“…Finally, the present study does not include a nondiabetic control group. However, a previous study indicates similar cardiac function changes in patients with type 2 diabetes and matched controls 27 …”

“…However, a previous study indicates similar cardiac function changes in patients with type 2 diabetes and matched controls. 27 The primary strength of the study is that the effects of hypoglycaemia and subsequent recovery in both hyperglycaemia and euglycaemia were successful, well-controlled and assessed in the same participant. Thus, we could compare the difference individually and limit potential confounding.…”