Monitoring of 24-h ECG and glucose level for detection of relations between glycemia and QT interval duration in type 1 diabetics


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Abstract

Aim. To study correlations between glycemia and duration of ventricular repolarization in children and adolescents with type 1 diabetes mellitus (DM).
Material and methods. Parallel monitoring of ECG and glycemia was conducted in 43 type 1 MD patients (age 7-17 years, 12.8 ± 2.7) and 37 healthy children and adolescents.
Results. Glycemia under 3 mmol/l and over 19 mmol/l is associated with significantly longer QTc interval compare to other blood glucose levels (437 ms and 447 ms versus 430 ms, p < 0.01). Also, in these glycemia values QTc interval duration over 440 ms (46 and 62% versus 33%; p<0.01) becomes more frequent. In healthy children and adolescents mean duration and frequency of a longer QTc interval were significantly less than in diabetic patients irrespective of glycemia degree in patients with type 1 DM (p < 0.01). A moderate correlation was found between a daily insulin dose and QTc duration (correlation coefficient 0.35, p = 0.02).
Conclusion. Glycemia under 3 mmol/l and over 19 mmol/l can prolong QT interval and, therefore, raise the risk of cardiovascular death in patients with type 1 DM.

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References

  1. Thordarson H., Sovik O. Dead in bed syndrome in young diabetic patients in Norway. Diabet. Med. 1995; 12 (9): 782-787.
  2. Marques J. L., George E., Peacey S. R. et al. Altered ventricular repolarisation during hypoglycaemia in patients with diabetes. Diabet. Med. 1997; 14 (8): 648-654.
  3. Robinson R. T., Harris N. D., Ireland R. H. et al. Mechanisms of abnormal cardiac repolarization during insulin-induced hypoglycemia. Diabetes 2003; 52: 1469-1474.
  4. Robinson R. T., Harris N. D., Ireland R. H. et al. Changes in cardiac repolarization during clinical episodes of nocturnal hypoglycaemia in adults with type 1 diabetes. Diabetologia 2004; 47: 312-315.
  5. Murphy N. P., Ford-Adams M. E., Ong K. K. et al. Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes. Diabetologia 2004; 47: 1940-1947.
  6. Marfella R., Nappo F., DeAngelis L. et al. The effect of acute hyperglycaemia on QTc duration in healthy men. Diabetologia 2000; 43: 571-575.
  7. Suys B., Heuten S., De Wolf D. et al. Glycemia and corrected QT interval prolongation in young type 1 diabetic patients: What is the relation? Diabet. Care 2006; 29: 427-429.
  8. Lee S., Harris N. D., Robinson R. T. et al. Effects of adrenaline and potassium on QTc interval and QT dispersion in man. Eur. J. Clin. Invest. 2003; 33: 93-98.
  9. Gavryck W. A., Moore R. D., Thompson R. C. Effect of insulin upon membrane bound (Na++K+)-ATPase extracted from frog skeletal muscle. J. Physiol (Jond.) 1975; 252: 43-58.
  10. Moore R. D. Stimulation of Na : H exchange by insulin. Biophys. J. 1981; 33: 203-210.
  11. Sredniawa B., Musialik-Lydka A., Jarski P. et al. Circadian and sexdependent QT dynamics. Pacing Clin. Electrophysiol. 2005; 28: S211-S216.
  12. Bazett H. C. An analysis of time relations of the electrocardiogram. Heart 1920; 7: 353-370.
  13. Garson A. Jr. How to measure the QT interval - what is normal? Am. J. Cardiol. 1993; 72: 14B-16B.
  14. Heller S. R. Abnormalities of the electrocardiogram during hypoglycemia: the cause of the dead in bed syndrome? Int. J. Clin. Pract. 2002; 129 (suppl.): 27-32.
  15. Eckert B., Agardh C. D. Hypoglycaemia leads to an increased QT interval in normal men. Clin. Physiol. 1998; 18: 570-575.
  16. Yue D. T., Herzig S., Marban E. Beta-adrenergic stimulation of calcium channels occurs by potentiation of high-activity gating models. Proc. Natl. Acad. Sci. USA 1990; 87: 742-747.
  17. Lee S. P., Harris N. D., Robinson R. T. et al. Effect of atenolol on QTc interval lengthening during hypoglycaemia in type 1 diabetes. Diabetologia 2005; 48: 1269-1272.
  18. Lee S. P., Yeoh L., Harris N. D. et al. Influence of autonomic neuropathy on QTc interval lengthening during hypoglycemia in type 1 diabetes. Diabetes 2004; 53: 1535-1542.
  19. Marfella R., Rossi F., Giugliano D. Hyperglycaemia and QT interval: time for reevaluation. Diabet. Nutr. Metab. 2001; 14: 63-65.
  20. McKenna K., Smith D., Tormey W. et al. Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in Type 1 diabetes mellitus. Diabet. Med. 2000; 17 (7): 512-517.
  21. Marfella R., Terrazzo G., Acampora R. et al. Glutathione reverses systemic hemodynamic changes by acute hyperglycemia in healthy subjects. Am. J. Physiol. 1995; 268: 1167-1173.
  22. Gastaldelli A., Emdin M., Conforti F. et al. Insulin prolong the QTc interval in humans. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2000; 279: 2022-2025.
  23. Dekker J. M., Feskens E. J. M., Schouten E. G. et al. The Zutphen Elderly Study: QTc duration is associated with levels of insulin and glucose tolerance. Diabetes 1996; 45: 376-380.
  24. Zierler K. Effect of insulin on membrane potential and potassium content of rat muscle. Am. J. Physiol. 1959; 197: 515-523.
  25. Zierler K., Wu F. S. Insulin acts on Na, K, and Ca currents. Trans. Assoc. Am. Physicians 1988; 101: 320-325.
  26. Campbell I. W. Dead in bed syndrome: a new manifestation of nocturnal hypoglycemia? Diabet. Med. 1991; 8: 3-4.

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