Baseline-Corrected QT (QTc) Interval Is Associated with Prolongation of QTc during Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus

다국어 초록 (Multilingual Abstract)

Background: We investigated an association between baseline heart rate-corrected QT (QTc) interval before severe hypoglycemia (SH) and prolongation of QTc interval during SH in patients with type 2 diabetes mellitus (T2DM).
Methods: Between January 2004 and June 2014, 208 patients with T2DM, who visited the emergency department because of SH and underwent standard 12-lead electrocardiography within the 6-month period before SH were consecutively enrolled. The QTc interval was analyzed during the incidence of SH, and 6 months before and after SH. QTc intervals of 450 ms or longer in men and 460 ms or longer in women were considered abnormally prolonged.
Results: The mean age and diabetes duration were 68.1±12.1 and 14.1±10.1 years, respectively. The mean QTc intervals at baseline and SH episodes were 433±33 and 460±33 ms, respectively (P<0.001). One hundred and fourteen patients (54.8%) had a prolonged QTc interval during SH. There was a significant decrease in the prolonged QTc interval within 6 months after SH (QTc interval prolongation during SH vs. after recovery, 54.8% vs. 33.8%, P<0.001). The prolonged QTc interval was significantly associated with baseline QTc interval prolongation (odds ratio, 2.92; 95% confidence interval, 1.22 to 6.96; P=0.016) after adjusting for multiple confounders.
Conclusion: A prolonged QTc interval at baseline was significantly associated with prolongation of the QTc interval during SH in patients with T2DM, suggesting the necessity of QTc interval monitoring and attention to those with a prolonged QTc interval to prevent SH.

참고문헌 (Reference)

1 Tsujimoto T, "Vital signs, QT prolongation, and newly diagnosed cardiovascular disease during severe hypoglycemia in type 1 and type 2 diabetic patients" 37 : 217-225, 2014

2 Wright RJ, "Vascular disease and diabetes: is hypoglycaemia an aggravating factor?" 24 : 353-363, 2008

3 Tattersall RB, "Unexplained deaths of type 1 diabetic patients" 8 : 49-58, 1991

4 Jones AG, "The clinical utility of C-peptide measurement in the care of patients with diabetes" 30 : 803-817, 2013

5 Bonds DE, "The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes:retrospective epidemiological analysis of the ACCORD study" 340 : b4909-, 2010

6 Zoungas S, "Severe hypoglycemia and risks of vascular events and death" 363 : 1410-1418, 2010

7 Darbar D, "Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease" 312 : 874-878, 1996

8 Gruden G, "QTc interval prolongation is independently associated with severe hypoglycemic attacks in type 1 diabetes from the EURODIAB IDDM complications study" 35 : 125-127, 2012

9 Stettler C, "QTc interval and resting heart rate as long-term predictors of mortality in type 1and type 2 diabetes mellitus: a 23-year follow-up" 50 : 186-194, 2007

10 Christensen TF, "QT interval prolongation during spontaneous episodes of hypoglycaemia in type 1 diabetes: the impact of heart rate correction" 53 : 2036-2041, 2010

11 Rana BS, "QT interval abnormalities are often present at diagnosis in diabetes and are better predictors of cardiac death than ankle brachial pressure index and autonomic function tests" 91 : 44-50, 2005

12 Barr CS, "QT dispersion and sudden unexpected death in chronic heart failure" 343 : 327-329, 1994

13 Levey AS, "National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification" 139 : 137-147, 2003

14 Selvin E, "Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus" 141 : 421-431, 2004

15 Cryer PE, "Mechanisms of hypoglycemia-associated autonomic failure in diabetes" 369 : 362-372, 2013

16 Robinson RT, "Mechanisms of abnormal cardiac repolarization during insulin-induced hypoglycemia" 52 : 1469-1474, 2003

17 National Kidney Foundation, "KDOQI clinical practice guideline for diabetes and CKD: 2012 update" 60 : 850-886, 2012

18 Ohkubo Y, "Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study" 28 : 103-117, 1995

19 ADVANCE Collaborative Group, "Intensive blood glucose control and vascular outcomes in patients with type 2diabetes" 358 : 2560-2572, 2008

20 Johnson ES, "Increasing incidence of serious hypoglycemia in insulin users" 55 : 253-259, 2002

21 김진택, "Increasing Trend in the Number of Severe Hypoglycemia Patients in Korea" 대한당뇨병학회 35 (35): 166-172, 2011

22 Seaquist ER, "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society" 98 : 1845-1859, 2013

23 Warren RE, "Hypoglycaemia and cognitive function" 7 : 493-503, 2005

24 Duckworth W, "Glucose control and vascular complications in veterans with type 2 diabetes" 360 : 129-139, 2009

25 Action to Control Cardiovascular Risk in Diabetes Study Group, "Effects of intensive glucose lowering in type 2 diabetes" 358 : 2545-2559, 2008

26 The DCCT Research Group, "Diabetes Control and Complications Trial (DCCT): results of feasibility study" 10 : 1-19, 1987

27 Workgroup on Hypoglycemia, American Diabetes Association, "Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia" 28 : 1245-1249, 2005

28 Secrest AM, "Characterizing sudden death and dead-in-bed syndrome in type 1diabetes: analysis from two childhood-onset type 1 diabetes registries" 28 : 293-300, 2011

29 Agarwal DP, "Cardioprotective effects of light-moderate consumption of alcohol: a review of putative mechanisms" 37 : 409-415, 2002

30 윤재승, "Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes" 대한내과학회 30 (30): 6-16, 2015

31 Stratton IM, "Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study" 321 : 405-412, 2000

32 Bazett HC, "An analysis of the time relation of electrocardiograms" 7 : 353-370, 1920

33 Rautaharju PM, "AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV. The ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology" 119 : e241-e250, 2009