胰岛素治疗的 2 型糖尿病患者低血糖、血糖变异性与心律失常风险的相关性：一项前瞻性、观察性研究。
Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study.
机构信息
Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
出版信息
Cardiovasc Diabetol. 2021 Dec 24;20(1):241. doi: 10.1186/s12933-021-01425-0.
BACKGROUND
Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease and mortality. Using a long-term monitoring approach, we investigated the association between episodes of hypoglycemia, glycemic variability and cardiac arrhythmias in a real-life setting.
METHODS
Insulin-treated patients with T2D (N = 21, [mean ± SD] age 66.8 ± 9.6 years, BMI 30.1 ± 4.5 kg/m, HbA1c 6.8 ± 0.4% [51.0 ± 4.8 mmol/mol]) were included for a one-year observational study. Patients were monitored with continuous glucose monitoring ([mean ± SD] 118 ± 6 days) and an implantable cardiac monitor (ICM) during the study period.
RESULTS
Time spend in hypoglycemia was higher during nighttime than during daytime ([median and interquartile range] 0.7% [0.7-2.7] vs. 0.4% [0.2-0.8]). The ICMs detected 724 episodes of potentially clinically significant arrhythmias in 12 (57%) participants, with atrial fibrillation and pauses accounting for 99% of the episodes. No association between hypoglycemia and cardiac arrhythmia was found during daytime. During nighttime, subject-specific hourly incidence of cardiac arrhythmias tended to increase with the occurrence of hypoglycemia (incident rate ratio [IRR] 1.70 [95% CI 0.36-8.01]) but only slightly with increasing time in hypoglycemia (IRR 1.04 [95% CI 0.89-1.22] per 5 min). Subject-specific incidence of cardiac arrhythmias during nighttime increased with increasing glycemic variability as estimated by coefficient of variation whereas it decreased during daytime (IRR 1.33 [95% CI 1.05-1.67] and IRR 0.77 [95% CI 0.59-0.99] per 5% absolute increase, respectively).
CONCLUSIONS
Cardiac arrhythmias were common in insulin-treated patients with T2D and were associated with glycemic variability, whereas arrhythmias were not strongly associated with hypoglycemia.
TRIAL REGISTRATION
NCT03150030, ClinicalTrials.gov, registered May 11, 2017. https://clinicaltrials.gov/ct2/show/NCT03150030.
背景
接受胰岛素治疗的 2 型糖尿病（T2D）患者存在发生低血糖的风险，而低血糖与心血管疾病和死亡率增加相关。本研究采用长期监测方法，在真实环境中研究了低血糖发作、血糖变异性与心律失常之间的关系。
方法
纳入 21 例接受胰岛素治疗的 T2D 患者（[平均 ± 标准差]年龄 66.8 ± 9.6 岁，BMI 30.1 ± 4.5 kg/m，HbA1c 6.8 ± 0.4% [51.0 ± 4.8 mmol/mol]）进行为期一年的观察性研究。研究期间，患者接受连续血糖监测（[平均 ± 标准差]118 ± 6 天）和植入式心脏监测仪（ICM）监测。
结果
夜间的低血糖时间占比高于日间（[中位数和四分位数间距]0.7% [0.7-2.7] vs. 0.4% [0.2-0.8]）。在 12 名（57%）参与者中，ICM 检测到 724 次潜在临床意义的心律失常事件，其中心房颤动和停搏占 99%的事件。日间未发现低血糖与心律失常之间存在关联。夜间，心律失常的每小时发生率随低血糖的发生而呈趋势性增加（发生率比 [IRR]1.70 [95%CI 0.36-8.01]），但随低血糖时间的延长而略有增加（每 5 分钟增加 1.04 [95%CI 0.89-1.22]）。夜间，心律失常的发生率随血糖变异性的增加而增加，而日间则呈下降趋势（分别为变异系数每增加 5%时 IRR 1.33 [95%CI 1.05-1.67]和 IRR 0.77 [95%CI 0.59-0.99]）。
结论
接受胰岛素治疗的 T2D 患者常见心律失常，与血糖变异性相关，而与低血糖无明显关联。
试验注册
NCT03150030，ClinicalTrials.gov，注册于 2017 年 5 月 11 日。https://clinicaltrials.gov/ct2/show/NCT03150030.
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