Effect of hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with and without type 1 diabetes: A prospective, randomised, open-label, blinded endpoint, cross-over study

TY - JOUR

T1 - Effect of hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with and without type 1 diabetes

T2 - A prospective, randomised, open-label, blinded endpoint, cross-over study

AU - Noh, Radzi M.

AU - Graveling, Alex J.

AU - Lang, Ninian N.

AU - White, Audrey C .

AU - Lee, Kuan Ken

AU - Mills, Nicholas L.

AU - Newby, David E.

AU - Lang, Chim C.

AU - Frier, Brian M.

N1 - The study was funded by the Scottish Chief Scientist office - CZB/4/721. DEN is supported by the British heart Foundation CH/09/002, RG/16/10/32375, RE/168/5/3421 and a Wellcome Trust Senior Investigator Award WT103782AIA

PY - 2021/7

Y1 - 2021/7

N2 - Aims: This study examined the effect of experimentally-induced hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with, and without, type 1 diabetes.Methods: In a prospective, randomised, open-label, blinded, endpoint cross-over study, 17 young adults with type 1 diabetes with no cardiovascular risk factors, and 10 healthy non-diabetic volunteers, underwent hyperinsulinaemic-euglycaemic (blood glucose 4.5–5.5 mmol/L) and hypoglycaemic (2.2–2.5 mmol/L) clamps. Myocardial blood flow was assessed using transthoracic echocardiography Doppler coronary flow reserve (CFR) and myocardial injury using plasma high-sensitivity cardiac troponin I (hs-cTnI) concentration.Results: During hypoglycaemia, coronary flow reserve trended non-significantly lower in those with type 1 diabetes than in the non-diabetic participants (3.54 ± 0.47 vs. 3.89 ± 0.89). A generalised linear mixed-model analysis examined diabetes status and euglycaemia or hypoglycaemia as factors affecting CFR. No statistically significant difference in CFR was observed for diabetes status (p =.23) or between euglycaemia and hypoglycaemia (p =.31). No changes in hs-cTnI occurred during hypoglycaemia or in the recovery period (p =.86).Conclusions: A small change in CFR was not statistically significant in this study, implying hypoglycaemia may require more than coronary vasomotor dysfunction to cause harm. Further larger studies are required to investigate this putative problem.

AB - Aims: This study examined the effect of experimentally-induced hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with, and without, type 1 diabetes.Methods: In a prospective, randomised, open-label, blinded, endpoint cross-over study, 17 young adults with type 1 diabetes with no cardiovascular risk factors, and 10 healthy non-diabetic volunteers, underwent hyperinsulinaemic-euglycaemic (blood glucose 4.5–5.5 mmol/L) and hypoglycaemic (2.2–2.5 mmol/L) clamps. Myocardial blood flow was assessed using transthoracic echocardiography Doppler coronary flow reserve (CFR) and myocardial injury using plasma high-sensitivity cardiac troponin I (hs-cTnI) concentration.Results: During hypoglycaemia, coronary flow reserve trended non-significantly lower in those with type 1 diabetes than in the non-diabetic participants (3.54 ± 0.47 vs. 3.89 ± 0.89). A generalised linear mixed-model analysis examined diabetes status and euglycaemia or hypoglycaemia as factors affecting CFR. No statistically significant difference in CFR was observed for diabetes status (p =.23) or between euglycaemia and hypoglycaemia (p =.31). No changes in hs-cTnI occurred during hypoglycaemia or in the recovery period (p =.86).Conclusions: A small change in CFR was not statistically significant in this study, implying hypoglycaemia may require more than coronary vasomotor dysfunction to cause harm. Further larger studies are required to investigate this putative problem.

KW - Cardiovascular function

KW - Coronary Flow Reserve

KW - Hypoglycaemia

KW - Myocardial Ischaemia

KW - Type 1 diabetes

KW - type 1 diabetes

KW - coronary flow reserve

KW - hypoglycaemia

KW - myocardial ischaemia

KW - cardiovascular function

UR - https://www.scopus.com/pages/publications/85105152878

U2 - 10.1002/edm2.258

DO - 10.1002/edm2.258

M3 - Article

C2 - 34277982

SN - 2398-9238

VL - 4

JO - Endocrinology, Diabetes & Metabolism

JF - Endocrinology, Diabetes & Metabolism

IS - 3

M1 - e00258

ER -