Department of Medicine, LifePoint Health, Danville, VA 24541, USA.
Department of Medicine, Harvard Medical School & Veteran Affairs Boston Healthcare System, Boston, MA 02132, USA.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):e2743-e2750. doi: 10.1210/clinem/dgac195.
There is a paucity of large-scale epidemiological studies on the link between severe hypoglycemia (SH) and corrected QT (QTc) interval prolongation in type 2 diabetes (T2DM).
To evaluate the association of SH with QTc prolongation in adults with T2DM.
Prospective cohort analysis of participants enrolled in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study without QTc prolongation at baseline. SH was assessed over a 24-month period. Incident QTc prolongation was ascertained using follow-up electrocardiograms. Modified Poisson regression was used to generate the risk ratio (RR) and 95% CI for QTc prolongation.
Among 8277 participants (mean age 62.6 years [SD 6.5], 38.7% women, 62.8% White), 324 had ≥1 SH episode (3.9%). Over a median of 5 years, 517 individuals developed QTc prolongation (6.3%). Participants with SH had a 66% higher risk of QTc prolongation (RR 1.66, 95% CI 1.16-2.38). The incidence of QTc prolongation was 10.3% (27/261) and 14.3% (9/63) for participants with 1 and ≥2 SH, respectively. Compared with no SH, RRs for patients with 1 and ≥2 SH episodes were 1.57 (95% CI 1.04-2.39) and 2.01 (95% CI 1.07-3.78), respectively. Age modified the association of SH with QTc prolongation (PInteraction = .008). The association remained significant among younger participants (<61.9 years [median age]: RR 2.63, 95% CI 1.49-4.64), but was nonsignificant among older participants (≥61.9 years: RR 1.37, 95% CI 0.87-2.17).
In a large population with T2DM, SH was associated with an increased risk of QTc prolongation independently of other risk factors such as cardiac autonomic neuropathy. The association was strongest among younger participants.
关于 2 型糖尿病（T2DM）患者严重低血糖（SH）与校正 QT（QTc）间期延长之间的关联，缺乏大规模的流行病学研究。
评估 T2DM 成人 SH 与 QTc 延长的相关性。
对 ACCORD（控制心血管风险行动中的糖尿病）研究中无基线 QTc 延长的参与者进行前瞻性队列分析。在 24 个月期间评估 SH。通过随访心电图确定 QTc 延长的发生率。采用改良泊松回归生成 QTc 延长的风险比（RR）和 95%置信区间（CI）。
在 8277 名参与者（平均年龄 62.6 岁[标准差 6.5]，38.7%女性，62.8%为白人）中，有 324 名发生了≥1 次 SH 发作（3.9%）。在中位数为 5 年的随访期间，有 517 名参与者发生了 QTc 延长（6.3%）。发生 SH 的参与者发生 QTc 延长的风险增加了 66%（RR 1.66，95%CI 1.16-2.38）。发生 1 次和≥2 次 SH 的参与者中，发生 QTc 延长的发生率分别为 10.3%（27/261）和 14.3%（9/63）。与无 SH 相比，发生 1 次和≥2 次 SH 发作的患者的 RR 分别为 1.57（95%CI 1.04-2.39）和 2.01（95%CI 1.07-3.78）。年龄改变了 SH 与 QTc 延长的关联（P 交互=0.008）。在年龄较小的参与者中（<61.9 岁[中位数年龄]：RR 2.63，95%CI 1.49-4.64），这种关联仍然显著，但在年龄较大的参与者中（≥61.9 岁：RR 1.37，95%CI 0.87-2.17）则不显著。
在患有 T2DM 的大型人群中，SH 与 QTc 延长的风险增加独立相关，而其他危险因素（如心脏自主神经病变）则无关。这种关联在年龄较小的参与者中最强。
