Hypoglycaemic episodes increase the risk of ventricular arrhythmia and sudden cardiac arrest in patients with type 2 diabetes—A nationwide cohort study

Hsieh, Yu‐Cheng; Liao, Ying‐Chieh; Li, Cheng‐Hung; Lin, Ji-Ping; Weng, Chi-Jen; Lin, Chun‐Pin; Lo, Chung Ping; Huang, Kuo‐Ching; Huang, Jin‐Long; Wang, Jun‐Sing; Wu, Tsu‐Juey; Sheu, Wayne Huey Herng

doi:10.1002/dmrr.3226

Cited by 13 publications

(8 citation statements)

References 39 publications

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“…19 studies confirmed a significant association between hypoglycemia and macrovascular complications (3,4,10,11,14,16,17,18,20,23,26,28,34,36,38,40,43,45,46). The pooled odds ratio was 1.81 (95% CI 1.70-1.94).…”

Section: Meta-analysis Association Between Hypoglycemia and Macro-andmentioning

confidence: 84%

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Mattishent

Loke

2021

Front. Endocrinol.

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AimsWe conducted a meta-analysis of serious adverse events (dementia, macro- and micro-vascular events, falls and fractures, and death) associated with hypoglycemia in older patients treated with glucose lowering drugs.Materials and MethodsMeta-analysis of studies reporting on hypoglycemia and adverse events. The search included studies from two previously published systematic reviews, and an updated search of MEDLINE and EMBASE from April 2014 to November 2019. We assessed study validity based on ascertainment of hypoglycemia, adverse events and adjustment for confounders, and conducted a random effects meta-analyses, assessing heterogeneity using the I2 statistic.ResultsWe included 44 studies involving 2,507,434 participants. Most of the studies used adjusted analysis for confounders and hypoglycaemic events were typically identified based on healthcare databases (severe events). Hypoglycemia was associated with increased likelihood of death in a meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval 1.75–2.32). Studies assessing mortality signal a time-response relationship with a higher risk of adverse events occurring within the first 90 days after hypoglycemia. Our meta-analysis of nine studies demonstrated that hypoglycaemic episodes were associated with dementia – pooled OR 1.50 (95% CI 1.29–1.74). Our meta-analysis of nineteen studies demonstrated associations between hypoglycaemia and macrovascular complications, pooled OR 1.81 (95% CI 1.70–1.94), and microvascular complications (two studies) pooled OR 1.77 (95% CI 1.49–2.10). There is also an association between hypoglycemia and cardiovascular death (six studies) – pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our meta-analysis of six studies demonstrated an association between hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44–2.21) and 1.68 (95% CI 1.37–2.07) respectively.ConclusionThis meta-analysis confirms previously reported concerns of serious harm following hypoglycemia, especially in the immediate time period after a hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a priority in this vulnerable population.

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Section: Meta-analysis Association Between Hypoglycemia and Macro-andmentioning

confidence: 84%

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Mattishent

Loke

2021

Front. Endocrinol.

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“…10 Yapılan bazı çalışmalarda hipoglisemi olan hastalarda DM süresi açısından fark gözlenmezken, bazı çalışmalarda DM süresi ile hipoglisemi varlığı arasında ilişki tespit edilmiştir. 7,[11][12][13][14][15][16] Yapılan çalışmalarda hem ciddi hem de hafif hipoglisemi atağı sıklığı insülin kullananlarda yüksek gözlenmiştir. 12,16,17 Bir çalışmada tip 2 DM hastalarında sadece insülin kullanımının hipoglisemi riskini 6,5 kat arttırdığı bulunmuştur.…”

Section: Discussionunclassified

Diyabet Merkezden Takipli Tip 2 Diabetes Mellitus Hastalarında Hipoglisemi Sıklığı ve Hipoglisemi Korkusu

ÇALIŞKAN

HACIAĞAOĞLU

TUZUN

et al. 2022

Turkish Journal of Family Medicine and Primary Care

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Giriş: Bu çalışma aile hekimliği yönelimli diyabet merkezi (AHYDM) ile hastane yönelimli diyabet merkezi (HYDM)’den takipli tip 2 diabetes mellitus (DM) hastalarında hipoglisemi sıklığı ve ilişkili faktörlerin karşılaştırılmasını amaçlamaktadır. Yöntem: Bu çalışmaya 1 Aralık 2017– 31 Aralık 2019 tarihleri arasında aynı hastaneye bağlı olan iki diyabet merkezine başvuran Tip 2DM hastaları dahil edilmiştir. Çalışmada hastane içerisinde yer alan ve İç Hastalıkları Kliniği tarafından yürütülen DM merkezi HYDM olarak kabul edilirken, hastane kampüsü dışında bulunan, Aile Hekimliği Kliniği tarafından yürütülen DM merkezi ise AHYDM olarak kabul edilmiştir. Her iki merkezdeki açlık plazma glukozu düzeyi en az iki defa 70 mg/dL’nin altında saptanan hastalar vaka grubuna dahil edilmiştir. Ardından, her bir merkezde vaka grubundaki hastalara yaş ve cinsiyet açısından eşleştirilmiş, hipoglisemi atağı bulunmayan Tip 2 DM hastaları kontrol grubu olarak kabul edilmiştir. Ayrıca, Hipoglisemi Korku Ölçeği (HKÖ) iki merkezdeki vaka grubuna da uygulanmıştır. Bulgular: Çalışmaya dahil edilen 240 hastanın 150 (%62,5)’si kadın idi. HYDM’deki tüm hastaların 53(%1,2)’ünde hipoglisemi saptanmışken, AHYDM’den katılan tüm hastaların 27(%0,31)’sinde hipoglisemi tespit edilmiştir. Her iki merkezdeki vaka grubunda DM süresi, insülin kullanım sıklığı ve toplam insülin dozu kontrol grubundan yüksekti (sırasıyla, HYDM için p=0,049, p<0,001, p=0,001; AHYDM için p=0,014, p<0,001, p=0,010). Ayrıca AHYDM'deki vaka grubunda hipoglisemi eğitimi alma sıklığı ve hipoglisemi eğitiminin yeterli olduğu algısı HYDM'ye göre daha yüksekti (sırasıyla p=0,029 ve p=0,046). İki merkezde de HKÖ’de fark bulunmamıştır (p>0,05). Sonuç: DM hastalarında, özellikle insülin kullanan ve T2DM süresi uzun olan hastalarda hipoglisemi açısından dikkatli değerlendirilmesi gereklidir. Ayrıca hastaların aile hekimleri tarafından hipoglisemi ile ilgili eğitilmesi hipoglisemi görülme sıklığını azaltabilir.

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“…The change in phenylalanine in our study might also be a response to the overconsumption of dopamine in RH. Moreover, phenylalanine can be used as an index of cardiovascular disease (CVD) (47). Magnusson demonstrated that the diabetes-predictive amino acid score (derived from tyrosine, isoleucine, and phenylalanine) strongly predicts the risk of CVD in T2DM (48), which appears to be partially mediated by the propensity for atherosclerosis, suggesting that disturbed amino acid metabolism may be a potential link to hypoglycemia and CVD.…”

Section: Other Changesmentioning

confidence: 99%

Altered Caffeine Metabolism Is Associated With Recurrent Hypoglycemia in Type 2 Diabetes Mellitus: A UPLC–MS-Based Untargeted Metabolomics Study

et al. 2022

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BackgroundRecurrent hypoglycemia (RH) is well known to impair awareness of hypoglycemia and increase the risk of severe hypoglycemia; the underlying mechanism requires further understanding. We aimed to investigate the metabolic characteristic profile for RH in type 2 diabetes mellitus (T2DM) patients and explore the potential metabolic mechanism and prevention strategies.MethodsWe screened 553 community-based T2DM patients. T2DM with RH (DH group, n=40) and T2DM without hypoglycemia (DC group, n=40) were assigned in the case-control study, matched by propensity score matching. Non-targeted, global metabolite profiling was conducted using ultra-high performance liquid chromatography-mass spectrometry. Principal component analysis and supervised projections to latent structures-discriminant analysis were constructed to evaluate the potential biomarkers. Metabolites with a fold change of >2.0 or <0.5, a t-test q-value <0.05, and variable importance in projection value of >1 were identified as significantly differential metabolites. MetaboAnalyst was performed to analyze the related metabolic pathways.ResultsWe identified 12 significantly distinct metabolites as potential biomarkers of RH, which were enriched in five pathways; the caffeine metabolic pathway was the most dominant related one. Caffeine and its main downstream metabolites (theophylline and paraxanthine, all q <0.05) were significantly lower during RH. The combination of these metabolites can serve as a reliable predictor biomarker for RH (area under the curve = 0.88). Regarding lipid metabolism, triglyceride was upregulated (P=0.003) and the O-Acylcarnitine was downregulated (q < 0.001). Besides, RH was accompanied by lower phenylalanine (q=0.003) and higher cortisone (q=0.005) levels.ConclusionsRH in T2DM is accompanied by caffeine, lipolysis, phenylalanine, and cortisone metabolism abnormalities. Caffeine might be a reliable candidate biomarker and potential prevention strategy for RH, but further validation studies are needed.Clinical Trial RegistryChi CTR 1900026361, 2019-10-3.

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Hypoglycaemic episodes increase the risk of ventricular arrhythmia and sudden cardiac arrest in patients with type 2 diabetes—A nationwide cohort study

Cited by 13 publications

References 39 publications

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents

Diyabet Merkezden Takipli Tip 2 Diabetes Mellitus Hastalarında Hipoglisemi Sıklığı ve Hipoglisemi Korkusu

Altered Caffeine Metabolism Is Associated With Recurrent Hypoglycemia in Type 2 Diabetes Mellitus: A UPLC–MS-Based Untargeted Metabolomics Study

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