Abstract

Hypoglycaemia is associated with increased cardiovascular risk among individuals with diabetes mellitus. It has been hypothesized that hypoglycaemia may trigger autonomic changes leading to increased cardiac arrhythmia risk. We conducted a systematic review and meta-analysis to explore this association. Ovid Medline, Embase, Scopus, Web of Science and Cochrane were searched from inception to October 10, 2017. We included studies of adults with diabetes (Type 1 or Type 2) that compared acute electrocardiogram (ECG) changes during episodes of hypoglycaemia and euglycaemia. Our search resulted in 4625 citations, among which 20 studies met the predefined inclusion criteria. Finally, 12 studies were included in the descriptive analysis and 15 in the meta-analysis. Overall hypoglycaemia was associated with a reduction in heart rate variability and an increase in arrhythmia occurrence. QTc interval length was more significantly prolonged during hypoglycaemia compared to euglycaemia (pooled mean difference [95% confidence intervals] [0.64 (0.27-1.01], P = ·001). Subgroup analysis based on diabetes type showed that QTc prolongation occurred in individuals with Type 1 and Type 2 diabetes; however, the change between euglycaemia reached statistical significance only among individuals with Type 1 diabetes. Our findings suggest that hypoglycaemia results in ECG alterations that are associated with increased risk of cardiac arrhythmia, which is associated with increased cardiovascular events and mortality. More clinical studies are needed to determine the cardiac risks of hypoglycaemia in individuals with diabetes, especially in Type 2 diabetes.

Highlights

  • The global prevalence of diabetes is increasing with estimates suggesting over 415 million adults are living with the condition, of which over 90% have Type 2 (T2DM).[1]

  • Overall hypoglycaemia was associated with a reduction in heart rate variability and an increase in arrhythmia occurrence

  • Our findings suggest that hypoglycaemia results in ECG alterations associated with increased cardiac arrhythmia risk which is associated with increased cardiovascular events and mortality

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Summary

Introduction

The global prevalence of diabetes is increasing with estimates suggesting over 415 million adults are living with the condition, of which over 90% have Type 2 (T2DM).[1]. Amongst individuals with T1DM, sudden deaths are rare,[11, 12] which suggests the interplay of several contributing factors which, under certain conditions, results in the development of adverse cardiac events. It has been hypothesised that hypoglycaemia may trigger acute electrocardiographic (ECG) changes which increase an individual’s vulnerability to arrhythmic events, leading to adverse outcomes such as sudden cardiac death.[13, 14] By being able to identify the underlying mechanisms, clinicians may be able to identify individuals most at risk and can modify and personalise management in high risk individuals and improve patient outcomes

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