Antecedent hypoglycemia impairs autonomic cardiovascular function implications for rigorous glycemic control
Diabetes, ISSN: 0012-1797, Vol: 58, Issue: 2, Page: 360-366
2009
- 193Citations
- 101Captures
- 1Mentions
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- Citations193
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- 186
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- Policy Citations4
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- Captures101
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- 95
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Hypoglycemia and Autonomic Nervous System Function; HypoANS
STUDY INFORMATION OFFICIAL TITLE: Hypoglycemia and Autonomic Nervous System Function CURRENT STATUS: Completed STUDY TYPE: Interventional SPONSOR AGENCY:Brigham and Women's HospitalCLASS:Other COLLABORATOR AGENCY:Beth Israel Deaconess
Article Description
OBJECTIVE-Glycemic control decreases the incidence and progression of diabetic complications but increases the incidence of hypoglycemia. Hypoglycemia can impair hormonal and autonomic responses to subsequent hypoglycemia. Intensive glycemic control may increase mortality in individuals with type 2 diabetes at high risk for cardiovascular complications. We tested the hypothesis that prior exposure to hypoglycemia leads to impaired cardiovascular autonomic function. RESEARCH DESIGN AND METHODS-Twenty healthy subjects (age 28 ± 2 years; 10 men) participated in two 3-day inpatient visits, separated by 1-3 months. Autonomic testing was performed on days 1 and 3 to measure sympathetic, parasympa- thetic, and baroreflex function. A 2-h hyperinsulinemic [hypoglycemic (2.8 mmol/l) or euglycemic (5.0 mmol/l)] clamp was performed in the morning and in the afternoon of day 2. RESULTS-Comparison of the day 3 autonomic measurements demonstrated that antecedent hypoglycemia leads to 1) reduced baroreflex sensitivity (16.7 ± 1.8 vs. 13.8 ± 1.4 ms/mmHg, P = 0.03); 2) decreased muscle sympathetic nerve activity response to transient nitroprusside-induced hypotension (53.3 ± 3.7 vs. 40.1 ± 2.7 bursts/min, P < 0.01); and 3) reduced (P < 0.001) plasma norepinephrine response to lower body negative pressure (3.0 ± 0.3 vs. 2.0 ± 0.2 nmol/l at -40 mmHg). CONCLUSIONS-Baroreflex sensitivity and the sympathetic response to hypotensive stress are attenuated after antecedent hypoglycemia. Because impaired autonomic function, including decreased cardiac vagal baroreflex sensitivity, may contribute directly to mortality in diabetes and cardiovascular disease, our findings raise new concerns regarding the consequences of hypoglycemia. © 2009 by the American Diabetes Association.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=63249134829&origin=inward; http://dx.doi.org/10.2337/db08-1153; http://www.ncbi.nlm.nih.gov/pubmed/19056608; https://diabetesjournals.org/diabetes/article/58/2/360/14851/Antecedent-Hypoglycemia-Impairs-Autonomic; https://dx.doi.org/10.2337/db08-1153
American Diabetes Association
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