Insulin-induced hypoglycemia associated with increased cardiac workload
medwireNews: Hyperinsulinemic hypoglycemia is associated with an increase in left ventricular ejection fraction (LVEF) among people with type 1 diabetes and healthy controls, suggests research presented at the virtual ADA 81st Scientific Sessions.
“Although great progress has been made in the development of new insulins and glucose monitoring, hypoglycemia still remains the most frequent adverse event in people with diabetes treated with insulin,” said presenting author Therese Fabricius (Nordsjællands Hospital, Hillerød, Denmark).
She added that “the association between hypoglycemia and cardiovascular mortality is poorly understood, and it’s debated whether there is a direct link” or whether multiple mechanisms are involved.
To investigate further, the researchers enrolled 22 individuals with type 1 diabetes (mean duration 23.8 years) and 16 healthy controls who underwent a hyperinsulinemic hypoglycemic glucose clamp, with cardiac ultrasound measurements taken at baseline and approximately 30 minutes into the hypoglycemic phase.
Fabricius reported that LVEF increased from an average of 58.1% at baseline to 63.7% during the hypoglycemic phase among people with type 1 diabetes, and from 58.0% to 64.7% in the healthy controls, a significant change in both groups. There was no significant difference in LVEF among people with type 1 diabetes versus healthy controls at either timepoint.
The team also measured mean global longitudinal strain (GLS) during the clamp period, finding no significant changes in the type 1 diabetes group, but the measure increased from –19.6% to –22.0% in the healthy controls.
“Recent data have demonstrated that GLS might be a more sensitive and earlier marker for cardiac dysfunction” than LVEF, said Fabricius, noting that a GLS of around –19% is normal, while a measure of –16% indicates that cardiac function is affected.
The researchers found no significant differences in heart rate or blood pressure from baseline to the hypoglycemic phase in people with type 1 diabetes and healthy controls.
Taken together, the study results suggest that “hypoglycemia increases the cardiac workload [and] may play a role in the acute cardiovascular consequences of a hypoglycemic event,” concluded the presenter.
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