Even Silent Hypoglycemia Induces Cardiac Arrhythmias

Clark, Amy L.; Best, Conor; Fisher, Simon J.

doi:10.2337/db14-0108

Cited by 26 publications

(18 citation statements)

References 18 publications

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“…There is agreement among providers and researchers that any hypoglycemia event requiring hospitalization or emergency care is a severe event. Nonetheless, a low glucose measurement at any time can be clinically meaningful due to its potential physiologic effects, even when the patient reports no symptoms …”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, a low glucose measurement at any time can be clinically meaningful due to its potential physiologic effects, even when the patient reports no symptoms. 10 Observational studies and clinical trials examining the effects of antihyperglycemic drugs have identified hypoglycemia events through various definitions. Our group recently developed a composite event definition for hypoglycemia using administrative claims and laboratory data which includes hospitalizations or emergency department (ED) visits due to hypoglycemia, and outpatient visits with an associated blood glucose measurement <60 mg/dL.…”

mentioning

confidence: 99%

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Accuracy of a composite event definition for hypoglycemia

Min

Presley

Wharton

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To evaluate the accuracy of a composite definition for the identification of hypoglycemia events that used both administrative claims and laboratory data in a cohort of patients. Methods We reviewed medical records in a sample of presumed hypoglycemia events among patients who received care at the Veterans Health Administration Tennessee Valley Healthcare System in 2001 to 2012. A hypoglycemia event was defined as a hospitalization or emergency department visit judged by the treating clinician to be due to hypoglycemia, or an outpatient laboratory or point‐of‐care blood glucose measurement <60 mg/dL. Based on medical record review, each event was classified as true positive (severe, documented symptomatic, documented asymptomatic) or false positive (probable symptomatic, not hypoglycemia). The positive predictive values (PPV) of the individual event types (hospitalization, emergency department, and outpatient) were estimated. Results Of 2250 events identified through the composite definition, 321 events (15 hospitalizations, 103 emergency department visits, and 203 outpatient events) were reviewed. The PPVs were 80% for hospitalization events, 48% for emergency department events, and 96% for outpatient events. The emergency department definition included a nonspecific diagnosis code for diabetic complications which captured many false positive events. Excluding this code from the definition improved the PPV for emergency department events to 70% and missed one true event. Conclusions Our composite definition for hypoglycemia performed moderately well in a cohort of Veterans. Further evaluation of the emergency department events may be needed.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Accuracy of a composite event definition for hypoglycemia

Min

Presley

Wharton

et al. 2019

Pharmacoepidemiology and Drug

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show abstract

“…However, outpatients with type 2 diabetes who are treated with insulin and/or sulfonylureas exhibit an increased frequency of asymptomatic mild and severe hypoglycemia, and severe hypoglycemia is associated with increased ventricular ectopy (17,18). Severe hypoglycemia is also independently associated with QTc interval prolongation in both type 2 and type 1 diabetes (17,19), and there are plausible biological mechanisms through which hypoglycemia could trigger acute cardiovascular events (20,21). …”

Section: Introductionmentioning

confidence: 99%

We Can Change the Natural History of Type 2 Diabetes

et al. 2014

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As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no “catch-up”—cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.

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“…[6] Arrhythmias are supposed to be more common during night-time hypoglycemia, possibly due to blunted nocturnal sympathoadrenal response and relatively increased parasympathetic activity. [7] Genetic predisposition to long QT syndrome can put a person with diabetes at risk of a fatal arrhythmia. [8] Malignant ventricular arrhythmia due to Brugada syndrome has also been postulated as a cause of sudden unexpected nocturnal death, since a glucose-insulin bolus can unmask the Brugada electrocardiographic signature in genetically predisposed individuals.…”

Section: W D B S ?mentioning

confidence: 99%

Dead in bed syndrome: Mystery and fear

Poudel¹,

Kafle²,

Belbase³

et al. 2015

Journal of Social Health and Diabetes

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Dead in bed (DIB) syndrome is a poorly understood cause of sudden and mysterious death in young people with type 1 diabetes on insulin therapy. Severe nocturnal hypoglycemia with unawareness is the most plausible mechanism which precipitates fatal arrhythmia in the vulnerable individual. Avoiding recurrent hypoglycemic episodes; screening for proarrhythmic condition in high-risk people with positive family history; and using real-time continuous glucose monitoring device in those with nighttime hypoglycemia and hypoglycemia unawareness can help to reduce the incidence of this deadly condition.

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Even Silent Hypoglycemia Induces Cardiac Arrhythmias

Cited by 26 publications

References 18 publications

Accuracy of a composite event definition for hypoglycemia

Accuracy of a composite event definition for hypoglycemia

We Can Change the Natural History of Type 2 Diabetes

Dead in bed syndrome: Mystery and fear

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