Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study

Andersen, Andreas; Sørensen, Samuel K.; Baldassarre, Maria Pompea Antonia; Pedersen‐Bjergaard, Ulrik; Forman, Julie Lyng; Gislason, Gunnar; Lindhardt, Tommi Bo; Knop, Filip K.; Vilsbøll, Tina

doi:10.1186/s12933-021-01425-0

Cited by 23 publications

(18 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, we showed that atrial fibrillation was more commonly detected during hospitalization in patients with high GV than those with low GV among the patients without previously reported AF. This finding is in line with the previous studies that revealed cardiac arrhythmias were common in insulin-treated patients with type 2 diabetes and are associated with GV [29], which was also independently associated with the development of new-onset atrial fibrillation in these diabetic patients [30].…”

Section: Glycemic Variability In Cardiovascular Diseasessupporting

confidence: 93%

In-hospital glycemic variability and all-cause mortality among patients hospitalized for acute heart failure

Park

et al. 2022

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background High glycemic variability (GV) is a poor prognostic marker in cardiovascular diseases. We aimed to investigate the association of GV with all-cause mortality in patients with acute heart failure (HF). Methods The Korean Acute Heart Failure registry enrolled patients hospitalized for acute HF from 2011 to 2014. Blood glucose levels were measured at the time of admission, during hospitalization, and at discharge. We included those who had 3 or more blood glucose measurements in this study. Patients were divided into two groups based on the coefficient of variation (CoV) as an indicator of GV. Among survivors of the index hospitalization, we investigated all-cause mortality at 1 year after discharge. Results The study analyzed 2,617 patients (median age, 72 years; median left-ventricular ejection fraction, 36%; 53% male). During the median follow-up period of 11 months, 583 patients died. Kaplan–Meier curve analysis revealed that high GV (CoV > 21%) was associated with lower cumulative survival (log-rank P < 0.001). Multivariate Cox proportional analysis showed that high GV was associated with an increased risk of 1-year (HR 1.56, 95% CI 1.26–1.92) mortality. High GV significantly increased the risk of 1-year mortality in non-diabetic patients (HR 1.93, 95% CI 1.47–2.54) but not in diabetic patients (HR 1.19, 95% CI 0.86–1.65, P for interaction = 0.021). Conclusions High in-hospital GV before discharge was associated with all-cause mortality within 1 year, especially in non-diabetic patients with acute HF.

show abstract

Section: Glycemic Variability In Cardiovascular Diseasessupporting

confidence: 93%

In-hospital glycemic variability and all-cause mortality among patients hospitalized for acute heart failure

Park

et al. 2022

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…(4,5) While there are different metrics representing glycemic variability in various aspects, the association between glycemic variability and severe hypoglycemia remains unclear because of the specific metrics applied in studies and heterogeneity of study design. Moreover, preventing hypoglycemia is prioritized by healthcare providers because it reduces the incidence of cardiac diseases, including cardiac arrhythmia and CVD ( 31 , 32 ). Future research could shift from emphasizing single metrics to combined glycemic-related metrics to improve the efficacy of predicting hypoglycemic events and reduce their occurrence.…”

Section: Discussionmentioning

confidence: 99%

Association of long-term visit-to-visit variability of HbA1c and fasting glycemia with hypoglycemia in type 2 diabetes mellitus

et al. 2022

View full text Add to dashboard Cite

BackgroundSelf-management of blood glucose levels to avoid hypoglycemia is vital for patients with type 2 diabetes mellitus (T2DM). The association between specific metrics of glycemic variability (glycosylated hemoglobin A1c [HbA1c] and fasting plasma glucose [FPG]) and severe hypoglycemia has not been fully studied in patients with T2DM.MethodsIn this post hoc analysis, patients with established T2DM with a high risk of cardiovascular disease were included in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The Cox proportional hazards model was used to investigate the relationship between glycemic variability and hypoglycemia requiring medical assistance (HMA) and hypoglycemia requiring any third-party assistance (HAA). The prognostic value of HbA1c/FPG variability for our predefined outcomes was compared using Harrell’s C method.ResultsAfter adjusting for confounders, each increase in HbA1c variability of 1 standard deviation (SD) indicated a higher risk of HAA (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.03–1.16; P < 0.01) and HMA events (HR: 1.11; 95% CI: 1.03–1.20; P < 0.01). Meanwhile, each increase in FPG variability of 1 SD increased the risk of HAA (HR: 1.40; 95% CI: 1.31–1.49; P < 0.01) and HMA events (HR: 1.46; 95% CI: 1.35–1.57; P < 0.01). Meanwhile, models, including FPG variability, had better prognostic value for our predefined outcomes than HbA1c variability (P < 0.01).ConclusionsIncreased visit-to-visit variability in HbA1c and fasting glycemia is associated with a greater risk of severe hypoglycemic events in T2DM patients. FPG variability is a more sensitive indicator than HbA1c variability.Trial registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT00000620.

show abstract

“…Among the complications of type 2 diabetes, hypoglycemia is a common and potentially serious complication of diabetes [ 9 , 10 ] which can lead to cognitive dysfunction, hemiplegia, blurred vision, decreased renal function, arrhythmia, coma, and even death [ 11 ]. The definition of type 2 diabetes mellitus with hypoglycemia is a glucose alert value of 3.9 mmol/L (70 mg/dL) or less.…”

Section: Introductionmentioning

confidence: 99%

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

Wang

Cheng

et al. 2023

BMC Psychiatry

View full text Add to dashboard Cite

Background The fear of hypoglycemia in type 2 diabetes mellitus (T2DM) patients with hypoglycemia has seriously affected their quality of life. They are always afraid of hypoglycemia and often take excessive action to avoid it. Yet, researchers have investigated the relationship between hypoglycemia worries and excessive avoiding hypoglycemia behavior using total scores on self-report measures. However, network analysis studies of hypoglycemia worries and excessive avoiding hypoglycemia behavior in T2DM patients with hypoglycemia are lacking. Purpose The present study investigated the network structure of hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia and aimed to identify bridge items to help them correctly treat hypoglycemia and properly deal with hypoglycemia fear. Methods A total of 283 T2DM patients with hypoglycemia were enrolled in our study. Hypoglycemia worries and avoiding hypoglycemia behavior were evaluated with the Hypoglycemia Fear Scale. Network analyses were used for the statistical analysis. Results B9 “Had to stay at home for fear of hypoglycemia” and W12 “I am worried that hypoglycemia will affect my judgment” have the highest expected influences in the present network. In the community of hypoglycemia worries, W17 “I worry about hypoglycemia during sleep” has the highest bridge expected influence. And in the community of avoiding hypoglycemia behavior, B9 “Had to stay at home for fear of hypoglycemia” has the highest bridge expected influence. Conclusion Complex patterns of associations existed in the relationship between hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia. From the perspective of network analysis, B9 “Had to stay at home for fear of hypoglycemia” and W12 “I am worried that hypoglycemia will affect my judgment” have the highest expected influence, indicating their highest importance in the network. W17 “I worry about hypoglycemia during sleep” aspect of hypoglycemia worries and B9 “Had to stay at home for fear of hypoglycemia” aspect of avoiding hypoglycemia behavior have the highest bridge expected influence, indicating they have the strongest connections with each community. These results have important implications for clinical practice, which provided potential targets for interventions to reduce hypoglycemia fear and improve the quality of life in T2DM patients with hypoglycemia.

show abstract

Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study

Cited by 23 publications

References 56 publications

In-hospital glycemic variability and all-cause mortality among patients hospitalized for acute heart failure

In-hospital glycemic variability and all-cause mortality among patients hospitalized for acute heart failure

Association of long-term visit-to-visit variability of HbA1c and fasting glycemia with hypoglycemia in type 2 diabetes mellitus

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

Contact Info

Product

Resources

About