Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark.
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Diabetes Obes Metab. 2022 Oct;24(10):2027-2037. doi: 10.1111/dom.14790. Epub 2022 Jul 27.
To investigate echocardiographic changes during acute hypoglycaemia followed by recovery to hyperglycaemia or euglycaemia in patients with type 1 diabetes.
In a randomized crossover study, 24 patients with type 1 diabetes took part in two experimental study days, consisting of a hyperinsulinaemic-euglycaemic phase (5.0-8.0 mmol/L) for 45 minutes followed by a hyperinsulinemic-hypoglycaemic phase (2.5 mmol/L) for 60 minutes, and a recovery phase in either hyperglycaemia (20 mmol/L) or euglycaemia (5.0-8.0 mmol/L) for 60 minutes. Cardiac function was evaluated with echocardiography during each phase.
Acute hypoglycaemia increased all markers of left ventricular (LV) systolic function, including LV ejection fraction (LVEF), global longitudinal strain (GLS), GLS rate and peak systolic velocity of mitral annular longitudinal movement (s'; P < 0.001 for all). During the recovery phases, all markers of LV systolic function were increased during hyperglycaemia (P < 0.01 for all), and LVEF and GLS remained increased during euglycaemia (P = 0.0116 and P = 0.0092, respectively). The increment in LVEF during the recovery phase was greater during hyperglycaemia than euglycaemia (P = 0.0046).
Hypoglycaemia, recent hypoglycaemia, and overcorrection of hypoglycaemia to rebound hyperglycaemia increased LV systolic function in type 1 diabetes and may imply consideration of plasma glucose when evaluating LV function in patients with type 1 diabetes. An increase in LV systolic function may cause increased strain on the heart and partly explain the link between hypoglycaemia, high glycaemic variability and cardiovascular disease.
研究 1 型糖尿病患者急性低血糖后恢复高血糖或正常血糖时的超声心动图变化。
在一项随机交叉研究中，24 例 1 型糖尿病患者参与了两项实验研究日，包括 45 分钟的高胰岛素-正常血糖期（5.0-8.0mmol/L），随后 60 分钟的高胰岛素-低血糖期（2.5mmol/L），以及高血糖（20mmol/L）或正常血糖（5.0-8.0mmol/L）的 60 分钟恢复期。在每个阶段都通过超声心动图评估心脏功能。
急性低血糖增加了所有左心室（LV）收缩功能的标志物，包括 LV 射血分数（LVEF）、整体纵向应变（GLS）、GLS 率和二尖瓣环纵向运动的收缩期峰值速度（s'；所有指标均 P<0.001）。在恢复期，高血糖期间所有 LV 收缩功能标志物均增加（所有指标均 P<0.01），而正常血糖期间 LVEF 和 GLS 仍保持增加（分别为 P=0.0116 和 P=0.0092）。恢复期 LVEF 的增加在高血糖期间大于正常血糖期间（P=0.0046）。
低血糖、近期低血糖和低血糖纠正至反弹高血糖均增加了 1 型糖尿病患者的 LV 收缩功能，在评估 1 型糖尿病患者的 LV 功能时可能需要考虑血糖。LV 收缩功能的增加可能会导致心脏负荷增加，并在一定程度上解释低血糖、高血糖变异性与心血管疾病之间的联系。
