Diabetes Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Department of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Diabetes Care. 2017 May;40(5):663-670. doi: 10.2337/dc16-1972. Epub 2017 Feb 21.
To determine the effect of sulfonylurea-related hypoglycemia on cardiac repolarization and ectopy in the setting of well-controlled type 2 diabetes.
Thirty subjects with sulfonylurea-treated type 2 diabetes underwent 48 h of concurrent continuous glucose monitoring and ambulatory electrocardiography. Ventricular repolarization (QTc) and QT dynamicity were analyzed during periods of hypoglycemia (<3.5 mmol/L for >20 min) and compared with periods of euglycemia and hyperglycemia combined. Cardiac ectopy rates during hypoglycemia were compared with ectopy rates when blood glucose was 4-10 mmol/L.
Mean HbA was 6.9% (52 mmol/mol). Hypoglycemia was detected in 9 of 30 subjects (30%); episodes were typically nocturnal (67%) and asymptomatic (73%). Hypoglycemia-associated QTc prolongation was seen in five of nine subjects with a large variation in individual response. Higher QT dynamicity, a poor prognostic factor in cardiac disease, was seen in subjects who experienced hypoglycemia compared with subjects who did not (0.193 vs. 0.159 for the nocturnal period; = 0.01). This finding persisted after the hypoglycemic event. The rates of ventricular and supraventricular ectopy demonstrated a nonsignificant trend toward an increase during hypoglycemia (median rate ratio 1.58 and 1.33, respectively). Similar, nonsignificant results were observed in a separate insulin-treated cohort.
Hypoglycemia, often unrecognized, is a frequent finding in well-controlled sulfonylurea-treated type 2 diabetes. It is associated with the novel finding of increased QT dynamicity and QTc prolongation in some individuals. Our findings suggest sulfonylurea-related hypoglycemia can have detrimental cardiovascular sequelae. Similar effects are also seen in the setting of insulin therapy.
确定磺酰脲类相关低血糖对血糖控制良好的 2 型糖尿病患者心脏复极和异位的影响。
30 名接受磺酰脲类药物治疗的 2 型糖尿病患者接受了 48 小时的连续血糖监测和动态心电图监测。在低血糖（<3.5mmol/L 持续>20 分钟）和高血糖合并期分析心室复极（QTc）和 QT 动态，并与正常血糖和高血糖期进行比较。低血糖期间的心律失常发生率与血糖为 4-10mmol/L 时的心律失常发生率进行比较。
平均 HbA1c 为 6.9%（52mmol/mol）。30 名患者中有 9 名（30%）出现低血糖；发作通常发生在夜间（67%）且无症状（73%）。9 名低血糖患者中有 5 名出现 QTc 延长，个体反应差异较大。与未发生低血糖的患者相比，发生低血糖的患者 QT 动态性更高（夜间期间分别为 0.193 和 0.159；=0.01）。这一发现在低血糖事件后仍然存在。室性和室上性心律失常的发生率在低血糖期间呈增加趋势，但无统计学意义（中位数率比分别为 1.58 和 1.33）。在另一组接受胰岛素治疗的患者中也观察到了类似的、无统计学意义的结果。
在血糖控制良好的磺酰脲类药物治疗的 2 型糖尿病患者中，低血糖是一种常见的、经常未被识别的现象。它与一些个体中 QT 动态性增加和 QTc 延长的新发现有关。我们的研究结果表明，磺酰脲类相关低血糖可能会对心血管系统产生不良后果。在胰岛素治疗中也观察到类似的影响。
