ArticleEuropean journal of endocrinology2021
Acute hypoglycemia and risk of cardiac arrhythmias in insulin-treated type 2 diabetes and controls.
Article in European journal of endocrinology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Glycemic variability and the risk of atrial fibrillation: a meta-analysis.Frontiers in endocrinology · 2023Pooled it
- Acute changes in plasma glucose increases left ventricular systolic function in insulin-treated patients with type 2 diabetes and controls.Diabetes, obesity & metabolism · 2022Trial
- Clinical and pathophysiological links between hypoglycemia and cardiovascular risk in type 2 diabetes mellitus.Frontiers in clinical diabetes and healthcare · 2026Review
- U-shaped association of the stress hyperglycemia ratio with all-cause mortality and premature death in patients with cardiovascular disease: a cohort study.Diabetology & metabolic syndrome · 2025Article
- The prognostic significance of stress hyperglycemia ratio in evaluating all-cause and cardiovascular mortality risk among individuals across stages 0-3 of cardiovascular-kidney-metabolic syndrome: evidence from two cohort studies.Cardiovascular diabetology · 2025Article
- Changes of the cardiac electrical cycle in type 1 diabetes during hypoglycaemia - a prospective observational study.Frontiers in endocrinology · 2025Observational
- Association of the neutrophil-to-lymphocyte ratio with sudden cardiac death in the patients with diabetic foot ulcer.Frontiers in endocrinology · 2025Article
- Contemporary Management and Prognostic Factors of Arrhythmia Recurrence in Patients with High-Energy Discharge of Cardiac Implantable Electronic Devices.Medicina (Kaunas, Lithuania) · 2024Article
- Brain Regulation of Cardiac Function during Hypoglycemia.Metabolites · 2023Review
- Dysglycemia and arrhythmias.World journal of diabetes · 2023Review
- Diabetes-induced chronic heart failure is due to defects in calcium transporting and regulatory contractile proteins: cellular and molecular evidence.Heart failure reviews · 2023Review
- Celebrities in the heart, strangers in the pancreatic beta cell: Voltage-gated potassium channels KActa physiologica (Oxford, England) · 2022Review
- In-hospital arrhythmic burden reduction in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: Insights from the SGLT2-I AMI PROTECT study.Frontiers in cardiovascular medicine · 2022Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveHypoglycemia is associated with an increased risk of cardiovascular disease including cardiac arrhythmias. We investigated the effect of hypoglycemia in the setting of acute glycemic fluctuations on cardiac rhythm and cardiac repolarization in insulin-treated patients with type 2 diabetes compared with matched controls without diabetes.
designA non-randomized, mechanistic intervention study.
methodsInsulin-treated patients with type 2 diabetes (n = 21, age (mean ± s.d.): 62.8 ± 6.5 years, BMI: 29.0 ± 4.2 kg/m2, HbA1c: 6.8 ± 0.5% (51.0 ± 5.4 mmol/mol)) and matched controls (n = 21, age: 62.2 ± 8.3 years, BMI 29.2 ± 3.5 kg/m2, HbA1c: 5.3 ± 0.3% (34.3 ± 3.3 mmol/mol)) underwent a sequential hyperglycemic and hypoglycemic clamp with three steady-states of plasma glucose: (i) fasting plasma glucose, (ii) hyperglycemia (fasting plasma glucose +10 mmol/L) and (iii) hyperinsulinemic hypoglycemia (plasma glucose < 3.0 mmol/L). Participants underwent continuous ECG monitoring and blood samples for counterregulatory hormones and plasma potassium were obtained.
resultsBoth groups experienced progressively increasing heart rate corrected QT (Fridericia's formula) interval prolongations during hypoglycemia ((∆mean (95% CI): 31 ms (16, 45) and 39 ms (24, 53) in the group of patients with type 2 diabetes and controls, respectively) with similar increases from baseline at the end of the hypoglycemic phase (P = 0.43). The incidence of ventricular premature beats increased significantly in both groups during hypoglycemia (P = 0.033 and P < 0.0001, respectively). One patient with type 2 diabetes developed atrial fibrillation during recovery from hypoglycemia.
conclusionsIn insulin-treated patients with type 2 diabetes and controls without diabetes, hypoglycemia causes clinically significant and similar increases in cardiac repolarization that might increase vulnerability for serious cardiac arrhythmias and sudden cardiac death.
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