Hypoglycaemia as cardiovascular risk factor
Authors:
Marián Mokáň; Peter Galajda
Authors‘ workplace:
I. interná klinika Jesseniovej LF UK a UNM, Martin
Published in:
Forum Diab 2014; 3(1): 20-27
Category:
Main Theme: Review
Overview
Hypoglycaemia is considered to be a new cardiovascular risk factor with influence on mortality of patients with diabetes mellitus. Hypoglycaemia is associated with hemodynamic changes, arrythmias, myocardial ischaemia and prothrombotic state as well as increased risk of cardiovascular events and increased cardiovascular mortality. On the other side there is marker of poor metabolic state with failure of contraregulatory function. In both cases is necessary to treat patients with diabetes mellitus by safe antidiabetic treatment with low risk of hypoglycaemia.
Key words:
cardiovascular risk factor – hypoglycaemia – type 2 diabetes mellitus
Sources
1. Mokáň M, Galajda P. Hypoglykémia pri vybraných vnútorných chorobách. Quick Print: Martin 2011. ISBN 978–80–970660–6–2.
2. Gerstein HC, Miller ME, Byington RP et al (The Action to Control Cardiovascular Risk in Diabetes Study Group). Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med 2008; 358(24): 2545–2559.
3. Patel A, MacMahon S, Chalmers J et al (ADVANCE Collaborative group). Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2008; 358(24): 2560–2572.
4. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129–139.
5. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood glucose control with metformin on complications in overweight patients with type 2 diabetes. (UKPDS 34). Lancet 1998; 352(9131): 854–865.
6. Holman RR, Paul SK, Bethel A et al. 10-Year Follow-Up of Intensive Glucose Control in Type 2 Diabetes. N Eng J Med 2008; 359(15): 1577–1589.
7. Turnbull FM, Abraira C, Andersoon RJ et.al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52(1): 2288–2298.
8. Tkáč I. Effect of intensive glycemic control on cardiovascular outcomes and all-cause mortality in type 2 diabetes: Overview and metaanalysis of five trials. Diab Res Clin Pract 2009; 86 (Suppl 1): S57-S62.
9. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ 2011; 343: d4169. Dostupné z DOI: <http://doi: 10.1136/bmj.d4169>.
10. Hemmingsen B, Lund SS, Gluud C et al.: Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ 2011; 343: d6898. Dostupné z DOI: <http://doi: 10.1136/bmj.d6898>.
11. Bonds DE, Miller ME, Bergenstal RM et al. The association between symptomatic severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 2010; 340: b4909. Dostupné z DOI: <http://doi: 10.1136/bmj.b4909>.
12. Zoungas S, Patel A, Chalmers J et al. (ADVANCE Collaborative Group). Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010; 363(15): 1410–1418.
13. Goyal A, Mehta S, Diaz R et al. Differential clinical outcomes associated with hypoglycemia and hyperglycemia in acute myocardial infarction. Circulation 2009; 120(24): 2429–2437.
14. Zarich SW. The role of intesive glycemic control in the management of patients who have acute myocardial infarction. Cardiol Clin 2005; 23(2): 109–117.
15. Svensson AM, McGuire DK, Abrahamson P et al. Association between hyper- and hypoglycaemia and 2-year all-caused mortality risk in diabetic patients with acute coronary events. Eur J Heart 2005; 26(13): 1255–1261.
16. Melbin LG, Malmberg K, Waldenstrom A et al. Prognostic implications of hypoglycaemic episode during hospitalisation for myocardial infarction in patiens with type 2 diabetes: a report from DIGAMI 2 trial. Heart 2009; 95(9): 921–927.
17. Whitcomb BW, Pradhan EK, Pittas AG et al. Impact of admission hyperglycemia on hospital mortality in various intensive care unit population. Crit Care Med 2005; 33(12): 2272–2277.
18. Fahy BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Crit Care Med 2009; 37(5): 1969–1976.
19. Van den Berghe G, Wouters P, Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345(19): 1359–1367.
20. Finfer S, Chittock DR, Su SY et al (NICE-SUGAR Study Investigators). Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360(13): 1283–1297.
21. Griesdale DEG, de Souza RJ, van Dam RB et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009; 180(8): 821–827.
22. Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: A meta-analysis. JAMA 2008; 300(8): 933–944.
23. Ceriello A, Zarich SW, Testa R et al. Lowering glucose to present averse cardiovascular outcomes in critical care setting. J Am Col Cardiol 2009; 53(Suppl 5): S9-S13.
24. Shan L, Hao PP, Chen YG. Efficacy and safety of intensive insulin therapy for critically ill neurologic patients: a meta-analysis. J Trauma 2011; 71(5): 1460–1464.
25. Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diab Metab Res Rew 2008; 24(5): 353–363.
26. Desouza CV, Bolli GB, Fonseca V. Hypoglycemia, diabetes, and cardiovascular events. Diabetes Care 2010; 33(6): 1389–1394.
27. Castaldo E, Sabato D, Lauro D et al. Hypoglycemia assessed by continuous glucose monitoring is associated with preclinical atherosclerosis in individuals with impaired glucose tolerance. PLosOne 2011; 6(12): e28312. Dostupné z DOI: <http://doi: 10.1371/journal.pone.0028312>.
28. Lipska KJ, Kosiborod M. Hypoglycemia and adverse outcomes: marker or mediator? Rev Cardiovasc Med 2011; 12(3): 132–135.
29. Nordin C. The case of hypoglycaemia as a proarrythmic event: basic and clinical evidence. Diabetologia 2010; 53(8): 1552–1561.
30. Galajda P, Mokáň M. Poruchy hemostázy pri diabetes mellitus. P+M: Martin 2001. 255 s.
31. Dantz D, Bewersdorf J, Fruehwald-Schultes B et al. Vascular endothelial growth factor: a novel endocrine defensive response to hypoglycemia. J Clin Endocrin Metab 2002; 37(2): 835–840.
32. Gogitidze JN, Hedrington MS, Briscoe VJ et al. Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care 2010; 33(7): 1529–1535.
33. Wright RJ, Newby DE, Stirling D et al. Effects of acute insulin-induced hypoglycemia on indices of inflammation: putative mechanism for aggravating vascular disease in diabetes. Diabetes Care 2010; 33(7): 1591–1597.
34. Kristensen PL, Høi-Hansen T, Olsen NV et al. Erythropoetin during hypoglycaemia in type 1 diabetes: Relation to basal renin-angiotensin system activity and cognitive function. Diab Res Clin Pract 2009; 85(1): 75–84.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
![Issue 1](https://www.forumdiabetologicum.sk/media/cache/resolve/journal_issue/media/image_pdf/1261352e2e219d5e3c6427eeb4a2080e.jpeg)
2014 Issue 1
Most read in this issue
- Acute complications of diabetes mellitus – incidence in patients in intensive care units and case report
- Hypoglycaemia in non-beta-cells tumours
- Hypoglycaemia as cardiovascular risk factor
-
Treatment of type 2 diabetes: How low do you go?
Treat early, treat safely!