Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
Acta Diabetol. 2017 Sep;54(9):871-876. doi: 10.1007/s00592-017-1018-6. Epub 2017 Jun 20.
To assess the independent role of severe hypoglycemia on 7-year cumulative incidence of prolonged QTc in a large cohort of patients with type 1 diabetes.
People with type 1 diabetes recruited by the EURODIAB Prospective Complications Study who had normal QTc were examined at baseline and after 7 years with standardized methods (n = 1415; mean age ± SD 32.1 ± 9.6 years; diabetes duration 14.2 ± 8.8 years). Hypoglycemic episodes were assessed by a questionnaire. QTc was calculated according to Bazett's formula. In logistic regression analysis, we examined the role of severe hypoglycemia (none, 1-2, or 3 and more episodes/year) on the cumulative incidence of prolonged QTc, independently of age, sex, HbA1c, blood pressure, BMI, physical activity, distal symmetrical and autonomic neuropathy.
In total, 264/1415 (17%) patients had incident prolonged QTc. Compared to those with persistently normal QTc, a greater proportion of incident cases had 3 and more hypoglycemic episodes at baseline (16.3 vs 11.2%, p = 0.03) and after 7 years (15.2 vs 9.6%, p = 0.01). In logistic regression analysis, 3 or more episodes of severe hypoglycemia at baseline did not increase cumulative incidence of prolonged QTc (OR 1.34, 95% CI 0.88-2.03). By contrast, severe hypoglycemia at the follow-up examination was associated with higher incidence of QTc prolongation (OR 1.68, 1.09-2.58), which reverted to not significant after adjustment for diabetic neuropathy.
Severe hypoglycemia was not associated with incidence QTc prolongation in type 1 diabetic patients from the EURODIAB PCS.
在一个大型 1 型糖尿病患者队列中，评估严重低血糖对 7 年累积性长 QT 发生率的独立作用。
通过 EURODIAB 前瞻性并发症研究招募的 1 型糖尿病患者，他们在基线和 7 年后使用标准化方法进行了检查（n=1415；平均年龄±标准差 32.1±9.6 岁；糖尿病病程 14.2±8.8 年）。通过问卷评估低血糖发作情况。根据 Bazett 公式计算 QTc。在逻辑回归分析中，我们检查了严重低血糖（无、1-2 次或 3 次及以上/年）对长 QTc 累积发生率的作用，独立于年龄、性别、HbA1c、血压、BMI、体力活动、远端对称性和自主神经病变。
总共，1415 例患者中有 264 例（17%）发生了长 QTc 事件。与持续正常 QTc 的患者相比，长 QTc 事件患者在基线时有更多的 3 次或更多低血糖发作（16.3%比 11.2%，p=0.03）和 7 年后（15.2%比 9.6%，p=0.01）。在逻辑回归分析中，基线时有 3 次或更多次严重低血糖发作并未增加长 QTc 的累积发生率（OR 1.34，95%CI 0.88-2.03）。相比之下，随访检查时严重低血糖与 QTc 延长的发生率更高（OR 1.68，1.09-2.58），但在调整糖尿病神经病变后不再显著。
在 EURODIAB PCS 的 1 型糖尿病患者中，严重低血糖与 QTc 延长的发生率无关。
