Visual Abstract

Insulin-treated patients with type 2 diabetes (T2D) are at risk of hypoglycemia, which is associated with an increased risk of cardiovascular disease. We investigated the association between episodes of hypoglycemia, glycemic variability and cardiac arrhythmias in a real-life setting. Insulin-treated patients with T2D (N=21, [mean±SD] age 66.8±9.6 years, BMI 30.1±4.5 kg/m2, HbA1c 6.8±0.4% [51.0±4.8 mmol/mol]) were included for a one-year observational study employing continuous glucose monitoring (118±6 days) and implantable cardiac monitors (ICMs).The ICMs detected 724 episodes of clinically relevant arrhythmias in 12 (57%) patients, with atrial fibrillation and pauses accounting for 99% of the episodes. No association between hypoglycemia and cardiac arrhythmia was found during daytime. During nighttime, subject-specific hourly incidence of cardiac arrhythmias tended to increase with the occurrence of hypoglycemia but only slightly with increasing time in hypoglycemia (Figure). Subject-specific incidence of cardiac arrhythmias during nighttime increased with increasing glycemic variability as estimated by coefficient of variation and standard deviation.

In conclusion, cardiac arrhythmias were common in insulin-treated patients with T2D and were associated with glycemic variability, whereas arrhythmias were not strongly associated with hypoglycemia.

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Disclosure

A. Andersen: None. T. Vilsbøll: Consultant; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Gilead Sciences, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk, Sanofi, Sun Pharmaceutical Industries Ltd. J. I. Bagger: None. S. K. Sørensen: Research Support; Self; Medtronic. M. Baldassarre: None. U. Pedersen-bjergaard: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis, Consultant; Self; Abbott, Speaker’s Bureau; Self; Novo Nordisk A/S. J. Forman: None. G. Gislason: None. T. B. Lindhardt: None. F. K. Knop: Advisory Panel; Self; MSD Corporation, Novo Nordisk A/S, Sanofi, Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Pharmacosmos, Zealand Pharma A/S, Research Support; Self; Novo Nordisk A/S, Zealand Pharma A/S, Speaker’s Bureau; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MSD Corporation, Novo Nordisk A/S.

Funding

Novo Nordisk Foundation (NNF16230); Capital Region of Denmark (E-19280-51-07)

© 2021 by the American Diabetes Association
2021
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