Association of hypoglycaemia and risk of cardiac arrhythmia in patients with diabetes mellitus: A systematic review and meta‐analysis

Fitzpatrick, Claire; Chatterjee, Sudesna; Seidu, Samuel; Bodicoat, Danielle H.; Ng, Guseva; Davies, Melanie J.; Khunti, Kamlesh

doi:10.1111/dom.13348

Cited by 44 publications

(34 citation statements)

References 52 publications

(125 reference statements)

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“…Thus, it is worthwhile knowing, that especially during hypoglycaemia, CGM‐derived data need to be questioned and may require confirmation by capillary BG measurements. This is also true for proCGM when used as a diagnostic tool, both in routine care and in outcome studies where the duration and frequency of hypoglycaemia need to be interpreted with caution …”

Section: Discussionmentioning

confidence: 99%

“…This is also true for proCGM when used as a diagnostic tool, both in routine care and in outcome studies where the duration and frequency of hypoglycaemia need to be interpreted with caution. 2,18 Some limitations of previous studies (short duration of experiment, lack of home phase, lack of sleep phase) were addressed. However, our study is limited by the rather small number of participants and the potential pressure artefacts (ie, on which side was the patient sleeping with regard to sensor performance).…”

Section: Discussionmentioning

confidence: 99%

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A head‐to‐head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot

Moser

Pandis

Aberer

et al. 2018

Diabetes Obesity Metabolism

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To compare the performance of a professional continuous glucose monitoring (proCGM) and a personal continuous glucose monitoring (persCGM) system worn in parallel under standardized conditions in individuals with type 1 diabetes (T1D), two CGM systems (iPro2 – proCGM; Minimed 640G – persCGM) worn in parallel using the same sensor (Enlite 2) were compared. Ten people with T1D were included in this single‐centre, open‐label study in which CGM performance was evaluated. The study consisted of a 24‐hours inpatient phase (meals, exercise, glycaemic challenges) and a 4‐day home phase. Analyses included fulfilment of ISO 15197:2013 criteria, mean absolute relative difference (MARD), Parkes Error Grid and Bland–Altman plots. During the inpatient stay, ISO 15197:2013 criteria fulfilment was 58.4% (proCGM) and 57.8% (persCGM). At home, the systems met ISO 15197:2013 criteria by 66.5% (proCGM) and 65.3% (persCGM). No difference of MARD in inpatient phase (19.1 ± 16.7% vs. 19.0 ± 19.6; P = 0.83) and home phase (18.6 ± 26.8% vs. 17.4 ± 21.3%, P = 0.87) was observed. All sensors performed less accurately during hypoglycaemia. ProCGM and persCGM showed similar performance during daytime and night‐time for the inpatient and the home phase. However, sensor performance was reduced during hypoglycaemia for both systems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A head‐to‐head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot

Moser

Pandis

Aberer

et al. 2018

Diabetes Obesity Metabolism

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“…20 A recently published meta-analysis confirmed that hypoglycaemia can result in ECG changes associated with cardiac arrhythmias that are markers of increased risk of mortality and cardiovascular events. 21 Cardiac arrhythmias may be an underlying factor that explains our findings of increased risk of myocardial infarction, stroke, falls and fractures, and death following hypoglycaemia. Nevertheless, the effects of hypoglycaemia on the cardiovascular physiology of frail, multi-morbid older patients with diabetes remains unclear.…”

Section: Discussionmentioning

confidence: 87%

“…For example, the study of Pistrosch et al of continuous glucose monitoring (CGM) and ambulatory cardiac monitoring found a link between hypoglycaemia and the occurrence of ventricular arrhythmias . A recently published meta‐analysis confirmed that hypoglycaemia can result in ECG changes associated with cardiac arrhythmias that are markers of increased risk of mortality and cardiovascular events . Cardiac arrhythmias may be an underlying factor that explains our findings of increased risk of myocardial infarction, stroke, falls and fractures, and death following hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study

Mattishent

Richardson

Dhatariya

et al. 2019

Diabetes Obesity Metabolism

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Aims: Older individuals with diabetes are susceptible to harm as the result of hypoglycaemia; however, the consequences of hypoglycaemia in older individuals with dementia are not known. We aimed to test the association between hypoglycaemia and serious adverse events in older patients with diabetes and dementia, and whether the consequences of hypoglycaemia were affected by the presence of dementia. Materials and methods: This was a cohort study using the Clinical Practice ResearchDatalink in England (1997England ( -2016. We selected participants, intervention (exposure) and follow-up to mirror two hypothetical target randomized controlled trials. The exposure of target trial 1 was hypoglycaemia in patients with dementia. Target trial 2 examined adverse effects of hypoglycaemia according to dementia status. We used Cox proportional hazard regression to estimate adjusted hazard ratios (aHR) for falls, fractures, cardiovascular events and mortality.Results: In target trial 1, hypoglycaemia was associated with increased risk during a 12-month follow-up period for falls and fractures (aHR, 1.94 [95% CI, 1.67-2.24]), for cardiovascular events (aHR, 2.00 [95% CI, 1.61-2.48]) and for mortality (aHR, 2.36 [95% CI, 2.09-2.67]). In target trial 2, the presence of dementia was associated with increased risk of adverse events, following hypoglycaemia, during a 12-month follow-up period for falls and factures (aHR, 1.72 [95% CI, 1.51-1.96]) and for mortality (aHR, 1.27 [95% CI, 1.15-1.41]), but dementia had no effect on cardiovascular events (aHR, 1.14 [95% CI, 0.95 to 1.36]). Conclusions: Hypoglycaemia is associated with early increased risk of serious adverse events in older individuals with diabetes and dementia. K E Y W O R D S cohort study, diabetes complications, hypoglycaemia, observational study, type 1 diabetes, type 2 diabetes

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“…Hypoglycemia is classified into three levels based on the standard for hypoglycemia suggested by the recent American Diabetes Association (ADA) guideline [13], i.e., hypoglycemia alert value (mild hypoglycemia), clinically significant hypoglycemia (moderate hypoglycemia), and severe hypoglycemia. Severe hypoglycemia and clinically significant hypoglycemia are associated with an increased risk of macrovascular events, microvascular disease, and all-cause death [14][15][16][17][18]. Mild hypoglycemia is traditionally thought to be harmful and should be avoided if possible.…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia during Short-Term Intensive Insulin Therapy and Its Association with Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes

Zhang

Huang

et al. 2020

Journal of Diabetes Research

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Background. Short-term intensive insulin therapy induces long-term glycemic remission in half of patients with newly diagnosed type 2 diabetes. The concomitant hypoglycemia needs further analysis. Methods. We collected data from three randomized trials conducted with the same inclusion and exclusion criteria at our institution from 2002 to 2015. Continuous subcutaneous insulin infusion (CSII) was provided to achieve the glycemic goals within a week and then maintained for 14 days. Hypoglycemia episodes during short-term treatment and the one-year drug-free glycemic remission were observed. Results. A total of 244 patients were included. The per day episode of mild hypoglycemia (3.0-3.9 mmol/L) was higher in the remission group than in the nonremission group (0.26±0.20 vs. 0.18±0.21, P=0.005). However, a moderate hypoglycemia episode (<3.0 mmol/L) per day was insignificantly lower in the remission group (0.02±0.04 vs. 0.03±0.04, P=0.221). After the cessation of insulin treatment, both acute insulin response (491.35 (801.89) vs. 370.22 (542.29), P=0.028) and homeostasis model assessment of insulin resistance (2.08 (2.04) vs. 2.48 (2.32), P=0.038) were more improved in the remission group than in the nonremission group. Logistic regression analysis showed that mild hypoglycemic episodes during short-term CSII treatment were independently related to a long-term glycemic remission (OR=2.18, 95% CI 1.02~4.70). Stratified analysis demonstrated that episodes during the continuing insulin dose reduction period played a substantial role. Conclusions. Mild hypoglycemic episodes during the continuing insulin dose reduction period indicate a long-term drug-free euglycemic remission in patients with newly diagnosed type 2 diabetes. However, the insulin dosage should be reduced even more quickly in the future treatment to decrease the potential harms.

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Association of hypoglycaemia and risk of cardiac arrhythmia in patients with diabetes mellitus: A systematic review and meta‐analysis

Cited by 44 publications

References 52 publications

A head‐to‐head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot

A head‐to‐head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot

The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all‐cause mortality in older individuals: A retrospective cohort study

Hypoglycemia during Short-Term Intensive Insulin Therapy and Its Association with Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes

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