Cardiovascular Health and Hypoglycemia
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.
Diabetes mellitus, Hypoglycemia, Cardiovascular risk, Arrhythmia
Fasanmade OA, Odeniyi IA. Cardiovascular Health and Hypoglycemia. In; Aggarwal S, Kalra S (eds) Insulin manual Chapter 39, 300-306pages