Hypoglycemia from a cardiologist's perspective

Vani P. Sanon, Saurabh Sanon, Rushit Kanakia, Hu Yu, Faris Araj, Rene A Oliveros, Robert J Chilton

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Hypoglycemia in people with diabetes mellitus (DM) has been potentially linked to cardiovascular morbidity and mortality. Pathophysiologically, hypoglycemia triggers activation of the sympathoadrenal system, leading to an increase in counter-regulatory hormones and, consequently, increased myocardial workload and oxygen demand. Additionally, hypoglycemia triggers proinflammatory and hematologic changes that provide the substrate for possible myocardial ischemia in the already-diseased diabetic cardiovascular system. Hypoglycemia creates electrophysiologic alterations causing P-R-interval shortening, ST-segment depression, T-wave flattening, reduction of T-wave area, and QTc-interval prolongation. Patients who experience hypoglycemia are at an increased risk of silent ischemia as well as QTc prolongation and consequent arrhythmias. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed an increase in all-cause mortality with intensive glycemic control, whereas the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study and Veteran's Affairs Diabetes Trial (VADT) showed no benefit with aggressive glycemic control. Women, elderly patients, and those with renal insufficiency are more vulnerable to hypoglycemic events. In fact, hypoglycemia is the most common metabolic complication experienced by older patients with DM in the United States. The concurrent use of medications like β-blockers warrants caution in DM because they can mask warning signs of hypoglycemia. Here we aim to elucidate the pathophysiology, review the electrocardiographic changes, analyze the current clinical literature, and consider the safety considerations of hypoglycemia as it relates to the cardiovascular system. In conclusion, in the current era of DM and its vascular ramifications, hypoglycemia from a cardiologist's perspective deserves due attention.

Original languageEnglish (US)
Pages (from-to)499-504
Number of pages6
JournalClinical Cardiology
Volume37
Issue number8
DOIs
StatePublished - 2014

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Hypoglycemia
Diabetes Mellitus
perindopril drug combination indapamide
Cardiovascular System
Gliclazide
Cardiologists
Mortality
Veterans
Masks
Workload
Vascular Diseases
Hypoglycemic Agents
Renal Insufficiency
Myocardial Ischemia
Blood Vessels
Cardiac Arrhythmias
Ischemia
Hormones
Oxygen
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sanon, V. P., Sanon, S., Kanakia, R., Yu, H., Araj, F., Oliveros, R. A., & Chilton, R. J. (2014). Hypoglycemia from a cardiologist's perspective. Clinical Cardiology, 37(8), 499-504. https://doi.org/10.1002/clc.22288

Hypoglycemia from a cardiologist's perspective. / Sanon, Vani P.; Sanon, Saurabh; Kanakia, Rushit; Yu, Hu; Araj, Faris; Oliveros, Rene A; Chilton, Robert J.

In: Clinical Cardiology, Vol. 37, No. 8, 2014, p. 499-504.

Research output: Contribution to journalArticle

Sanon, VP, Sanon, S, Kanakia, R, Yu, H, Araj, F, Oliveros, RA & Chilton, RJ 2014, 'Hypoglycemia from a cardiologist's perspective', Clinical Cardiology, vol. 37, no. 8, pp. 499-504. https://doi.org/10.1002/clc.22288
Sanon VP, Sanon S, Kanakia R, Yu H, Araj F, Oliveros RA et al. Hypoglycemia from a cardiologist's perspective. Clinical Cardiology. 2014;37(8):499-504. https://doi.org/10.1002/clc.22288
Sanon, Vani P. ; Sanon, Saurabh ; Kanakia, Rushit ; Yu, Hu ; Araj, Faris ; Oliveros, Rene A ; Chilton, Robert J. / Hypoglycemia from a cardiologist's perspective. In: Clinical Cardiology. 2014 ; Vol. 37, No. 8. pp. 499-504.
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