Cardiac arrhythmias and electrophysiologic responses during spontaneous hyperglycaemia in adults with type 1 diabetes mellitus - 26/02/21

Doi : 10.1016/j.diabet.2021.101237

Alan Bernjak ^a,^b,^{^{1
Alan Bernjak and Peter Novodvorsky should be considered joint first authors.}}, Peter Novodvorsky ^a,^c,^{^{1
Alan Bernjak and Peter Novodvorsky should be considered joint first authors.}}, Elaine Chow ^c,^d,^{^{2
Present address: Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong.}}, Ahmed Iqbal ^a,^c,^d, Lianne Sellors ^a,^c, Scott Williams ^a,^c, Robert A. Fawdry ^a,^c, Jefferson L.B. Marques ^a,^{^{3
Present address: Institute of Biomedical Engineering. Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianopolis-SC, Brazil.}}, Richard M. Jacques ^e, Michael J. Campbell ^e, Paul J. Sheridan ^c,^d, Simon R. Heller ^a,^c,⁎
^a Department of Oncology & Metabolism, University of Sheffield, Sheffield, United Kingdom
^b INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
^c Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
^d Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
^e School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom

^⁎Corresponding author at: Department of Oncology & Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, United Kingdom.Department of Oncology & MetabolismUniversity of SheffieldMedical SchoolBeech Hill RoadSheffieldS10 2RXUnited Kingdom

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Friday 26 February 2021
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

•	Spontaneous hyperglycaemia didn’t prolong QT_c interval in people with T1DM and without history of cardiovascular disease independently of the type of insulin used or their insulin regimen.
•	Cardiac arrhythmias were uncommon and confined to bradycardia and ectopic beats.
•	There was considerable diurnal and inter-subject variability in the incidences of arrhythmias.
•	Reassuringly, hyperglycaemia wasn’t linked with clinically relevant arrhythmias.

Le texte complet de cet article est disponible en PDF.

ABSTRACT

Aim

We examined the effect of spontaneous hyperglycaemia in adults with type 1 diabetes mellitus (T1DM) and without history of cardiovascular disease on heart rate variability (HRV), cardiac repolarisation and incidence of cardiac arrhythmias.

Methods

Thirty-seven individuals with T1DM (age 17-50 years, 19 males, mean duration of diabetes 19.3 SD(9.6) years) underwent 96 hours of simultaneous ambulatory 12-lead Holter ECG and blinded continuous interstitial glucose (IG) monitoring (CGM). HRV, QT interval and cardiac repolarisation were assessed during hyperglycaemia (IG ≥ 15 mmol/l) and compared with matched euglycaemia (IG 5-10 mmol/l) on a different day, separately during the day and night. Rates of arrhythmias were assessed by calculating incidence rate differences.

Results

Simultaneous ECG and CGM data were recorded for 2395 hours, During daytime hyperglycaemia vs euglycaemia the mean QT_c interval duration was 404 SD(21)ms vs 407 SD(20)ms, P = 0.263. T-peak to T-end interval duration corrected for heart rate (T_pT_endc) shortened (74.8 SD(16.1)ms vs 79.0 SD(14.8)ms, P = 0.033) and T-wave symmetry increased (1.62 SD(0.33) vs 1.50 SD(0.39), P = 0.02). During night-time hyperglycaemia vs euglycaemia, the mean QT_c interval duration was 401 SD(26)ms vs 404 SD(27)ms, P = 0.13 and T_pT_end shortened (62.4 SD(12.0)ms vs 67.1 SD(11.8)ms, P = 0.003). The number of cardiac arrhythmias was low and confined to bradycardia and isolated ectopic beats. A considerable inter-subject and diurnal variability was observed.

Conclusions

Hyperglycaemia in individuals with T1DM without known cardiovascular disease was not associated with clinically important cardiac arrhythmias.

Le texte complet de cet article est disponible en PDF.

Keywords : Cardiac arrhythmias, Cardiac electrophysiology, Heart rate variability (HRV), Hyperglycaemia, QT_c interval, Type 1 diabetes mellitus (T1DM)