QT Interval Abnormalities in Sulfonylurea Treated Type 2 Diabetes: Relationship to Treatment Induced Hypoglycaemia and Glycaemic Variability Determined by Simultaneous Ambulatory Monitoring
Abstract
Type 2 diabetes (T2DM) is an increasingly common condition and the associated cardiovascular morbidity is substantial. An area of particular concern is hypoglycaemia and there is increasing evidence that iatrogenic hypoglycaemia is linked to adverse cardiovascular outcomes. Studies have, for the most part, examined insulin treated subjects. Until now there has not been a dedicated examination of the short term cardiovascular effects of hypoglycaemia in subjects receiving sulfonylurea (SU) therapy under free-living conditions. Chapter 2 describes an observational study of thirty SU-treated T2DM subjects who underwent 48 hours of concurrent continuous glucose monitoring (CGM) and Holter monitoring (HM). Nine of thirty (30%) participants recorded SU-related hypoglycaemia on CGM, the majority of which was nocturnal and asymptomatic. An important focus of the study was the analysis of ventricular repolarisation in the context of hypoglycaemia. While a consistent ventricular response to hypoglycaemia was not observed, increased QT dynamicity and a trend toward increased cardiac ectopy were identified. Chapter 3 extends upon the analysis of CGM and HM data with a focus on glycaemic variability (GV) and variability of ventricular repolarisation. A clear association between GV and variability of ventricular repolarisation was not established. In those subjects who experienced hypoglycaemia, a significant correlation between GV and change in corrected QT interval length during…
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