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Changes in cardiac repolarisation during spontaneous nocturnal hypoglycaemia in subjects with type 1 diabetes: a preliminary report

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Abstract

Aims

Experimental studies have revealed that hypoglycaemia can result in morphological changes in electrocardiographic repolarisation in subjects with type 1 diabetes. However, the influence of spontaneous nocturnal hypoglycaemia on repolarisation morphology in a ‘real life’ situation is not clear.

Methods

Adults with type 1 diabetes (n = 11) underwent continuous glucose monitoring with a subcutaneous sensor and digital 12-lead ECG recording for three nights. T-wave morphology was analysed with custom-made software during both hypoglycaemia (glucose <3.5 mmol/l at least 20 min) from ten consecutive heart beats in the middle of the deepest hypoglycaemia and from a control nonhypoglycaemic period (glucose ≥5.0 mmol/l) from the same recording.

Results

In the comparison of 10 hypoglycaemia-control pairs, heart rate (65 ± 12 beats/min during normoglycaemia versus 85 ± 19 beats/min during hypoglycaemia, p = 0.028) increased and the QTc interval (439 ± 5 vs. 373 ± 5 ms, respectively, p = 0.025) decreased significantly during hypoglycaemia. The spatial QRS-T angle (TCRT) was reduced, and the roughness of the T-wave loop (T-E) increased significantly (p = 0.037 for both) in the patients during hypoglycaemia.

Conclusions

In adults with type 1 diabetes, spontaneous nocturnal hypoglycaemia results in morphological changes and increased heterogeneity of global cardiac repolarisation. These changes may contribute to the risk of ‘dead in bed’ syndrome encountered in young individuals with type 1 diabetes.

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Acknowledgements

This study was supported by a research grant from the Finnish Diabetes Research Foundation, from Polar Electro, Kempele, Finland and from Sigrid Juselius Foundation, Helsinki, Finland .

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu, P.O.Box 5000, Kajaanintie 50, Oulu, Finland

    Minna L. Koivikko, Tuomas Kenttä, Pasi I. Salmela, Heikki V. Huikuri & Juha S. Perkiömäki

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  1. Minna L. Koivikko
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  2. Tuomas Kenttä
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  3. Pasi I. Salmela
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  4. Heikki V. Huikuri
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  5. Juha S. Perkiömäki
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Correspondence to Minna L. Koivikko.

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The authors declare that they have no conflict of interest.

Human and animal rights

All procedures performed in the study involving human participants were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Koivikko, M.L., Kenttä, T., Salmela, P.I. et al. Changes in cardiac repolarisation during spontaneous nocturnal hypoglycaemia in subjects with type 1 diabetes: a preliminary report. Acta Diabetol 54, 251–256 (2017). https://doi.org/10.1007/s00592-016-0941-2

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  • DOI: https://doi.org/10.1007/s00592-016-0941-2

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