Cardiovascular Health and Hypoglycemia
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Date
2020
Authors
Fasanmade, O.A
Odeniyi, I.A
Journal Title
Journal ISSN
Volume Title
Publisher
Evangel Publishers
Abstract
The IDF and ADA working group describe hypoglycemia as exposure of
individual to low plasma glucose levels leading to potential harm. Apart
from complications related to microvascular and macrovascular disease,
great morbidity is also seen in these patients as a result of hypoglycemia
consequent upon various therapeutic interventions. Findings from the United
Kingdom Prospective Diabetes Study (UKPDS) and the Diabetes Control and
Complications Trial (DCCT) have driven intensification of diabetes glycemic
control. However, increased mortality was attributed to hypoglycemia in the
3 landmark trials (ACCORD ADVANCE and VADT ).
The agents implicated the most in the development of hypoglycemia are
the insulin secretagogues and insulin. Other risk factors include advanced
age, long duration of diabetes, renal impairment, missed/irregular meals.
Growing body of evidence has linked hypoglycemia with development of
adverse cardiovascular outcomes. The sympathoadrenal system is activated,
there is a change in hemorheology as inflammatory changes and endothelial
dysfunction also occur. There is a reduction in coronary artery perfusion during
hypoglycemic episodes leading to myocardial ischemia. Hypoglycemia also
causes ST wave changes, prolonged QT intervals and cardiac repolarization.
This increases the risk of arrhythmias.
With the great burden that hypoglycemia is now adding to diabetes
morbidity and mortality several steps should be taken to prevent hypoglycemia.
Some of them are factored into the choice of treatment patients are given,
others are considered in the glycemic targets and in others there has been
more education and measures instituted to limit the time spent in reported
and unreported hypoglycemia. Some of the newer glucose lowering agents
demonstrate a substantially reduced rate of hypoglycemia and are effective in
improving glycemic control.
Description
book chapter
Keywords
Diabetes mellitus, Hypoglycemia, Cardiovascular risk, Arrhythmia
Citation
Fasanmade OA, Odeniyi IA. Cardiovascular Health and Hypoglycemia. In; Aggarwal S, Kalra S (eds) Insulin manual Chapter 39, 300-306pages