Vital Signs, QT Prolongation, and Newly Diagnosed Cardiovascular Disease during Severe Hypoglycemia in Type 1 and Type 2 Diabetic Patients
- Tetsuro Tsujimoto, M.D.1,2,
- Ritsuko Yamamoto-Honda, M.D., Ph.D.1,3,
- Hiroshi Kajio, M.D., Ph.D.1,
- Miyako Kishimoto, M.D., Ph.D.1,3,
- Hiroshi Noto, M.D., Ph.D.1,3,
- Remi Hachiya, M.D.1,
- Akio Kimura, M.D., Ph.D.4,
- Masafumi Kakei, M.D., Ph.D.2,5 and
- Mitsuhiko Noda, M.D., Ph.D.1,3
- 1Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- 2Division of General Medicine, Jichi Medical University Graduate School of Medicine
- 3Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
- 4Department of Emergency Medicine and Critical Care, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- 5First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan
- Corresponding Author: Mitsuhiko Noda, E-mail:
Objective To assess vital signs, QT intervals, and newly diagnosed cardiovascular disease during severe hypoglycemia in diabetic patients.
Research Design and Methods From January 2006 to March 2012, we conducted a retrospective cohort study to assess type 1 and type 2 diabetic patients with severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that could not be resolved by the patients themselves in prehospital settings.
Results A total of 59,602 cases that visited the emergency room by ambulance were screened, and 414 cases of severe hypoglycemia were analyzed. The median (interquartile range) blood glucose levels were not significantly different between the type 1 diabetes (T1DM, n = 88) and type 2 diabetes (T2DM, n = 326) groups [32 (24-42) vs. 31 (24-39) mg/dL, P = 0.59]. During severe hypoglycemia, the incidences of severe hypertension (≥180/120 mmHg), hypokalemia (<3.5 mEq/L), and QT prolongation were 19.8% and 38.8% (P = 0.001), 42.4% and 36.3% (P = 0.30), and 50.0% and 59.9% (P = 0.29) in the T1DM and T2DM groups, respectively. Newly diagnosed cardiovascular disease during severe hypoglycemia and death were only observed in the T2DM group (1.5% and 1.8%, respectively). Blood glucose levels between the deceased and surviving patients in the T2DM group were significantly different [18 (14-33) mg/dL vs. 31 (24-39) mg/dL, P = 0.02].
Conclusions Type 1 and type 2 diabetic patients with severe hypoglycemia experienced many critical problems that could lead to cardiovascular disease, fatal arrhythmia, and death.
- Received March 22, 2013.
- Accepted August 3, 2013.
- © 2013 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.