Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions

Abstract

In conclusion, our study suggests that hypoglycemia might be able to trigger at least under certain circumstances, such as low TSH, ventricular arrhythmias under real-world conditions. The large number of unrecognized HE and VT in vulnerable patients treated with insulin or sulfonylurea should encourage the practitioner to focus on stable glucose control and to search for silent HE.

Inobvious complications of hypoglycaemia

“…Hypoglycaemia-induced heart rhythm disorders are particularly dangerous in patients with cardiovascular diseases in whom catecholamine hypersecretion may increase oxygen requirement and the exacerbation of ischaemia. Ventricular arrhythmias in patients with type 2 diabetes and cardiovascular disease may be above 30 times more frequent than in patients without hypoglycaemia [22]. It is extremely important that in the cited study only 39% of patients noted hypoglycaemic symptoms during the day, and even fewer -11% -reported nocturnal hypoglycaemia.…”

“…Disorders including QT prolongation and ventricular arrhythmias related to hypoglycaemia were also reported in patients with type 2 diabetes [21,22]. This problem affects not only patients treated with insulin but also those receiving sulfonylureas [22,23].…”

“…This problem affects not only patients treated with insulin but also those receiving sulfonylureas [22,23]. Hypoglycaemia-induced heart rhythm disorders are particularly dangerous in patients with cardiovascular diseases in whom catecholamine hypersecretion may increase oxygen requirement and the exacerbation of ischaemia.…”

Role of diabetes in heart rhythm disorders

“…A recent metaanalyses published by Huxley et al [3] revealed that patients with DM had a 40% greater risk of developing AF compared to patients without. On the other hand, there has been growing evidence about the relationship between hypoglycaemic episodes and ventricular rhythm disorders for the recent years [4,5] . The relationship between DM and arrhythmic disorders is not fully understood yet and there is a growing population of DM patients everyday.…”

“…There were high incidence of hypoglycemia and silent VA in the insulin and/ or SU group comparing to control subjects. A study from Pistrosch et al [5] further analyzed effects of hypoglycemia as a trigger for VA in larger patient cohort with type 2 DM revealed that hypoglycemia might be able to trigger VA and interestingly a tiroid stimulating hormone level in the low normal range, which indicates subclinical hypertiroidism, is indepently associated with occurrence of VA. Although these two studies provide no causal relationship between hypoglycemia and VA in diabetic patients, it may be postulated that hypoglycemia may be triggering VA either with sympathetic overstimulation or QT prolongation [36] .…”