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VOLUME 9 NUMBER 2 • JUNE 2012
CONFERENCE REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Hypoglycaemic events mark
vulnerability
Prof Brian Frier, honorary
professor of diabetes
at the University of
Edinburgh, affiliated
to the BHF Centre for
Cardiovascular Science.
and not correlated to low glucose levels’,
Prof Freir warned.
Hypoglycaemia provokes profound
haemodynamic changes through sympatho-
adrenal activation, resulting in the profuse
secretion of catecholamines.
24
This can
provoke ECG-abnormalities; prolongation
of the QT interval, and abnormalities in
AV conduction (due also to a fall in plasma
potassium), which are associated with a risk
of life-threatening cardiac arrhythmias.
Hypoglycaemic events adversely affect
quality of life and ‘having events, increases
the fear of having further events’. Dr Frier
said. The rate of hypoglycaemic events
induced by incretin-based therapies is trivial,
as these drugs promote glucose-dependent
insulin secretion’, Prof Frier concluded.
Peter Wagenaar, Glenda Hardy,
Julia Aalbers
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‘Hypoglycaemia is a marker of a patient’s
vulnerability to a wide spectrum of cardio-
vascular, cerebrovascular and musculo-
skeletal events. It is not a transient event, as
commonly perceived. There are longer-term
effects on cardiac function, platelets, the
inflammatory response and overall endothe-
lial function’.
Expressing this view, Prof Brian Frier,
University of Edinburgh, drew on his clinical
insightsgainedfromaresearchcareer focused
on the pathophysiology of hypoglycaemia.
While hypoglycaemia is more common in
type 1 diabetes patients, type 2 diabetes
patients on insulin experience on average
one severe event per month.
‘In the definitive UK Hypoglycaemia
study,
22
we were surprised to see in a real-
world setting that hypoglycaemia in type 2
diabetes patients treatedwith sulphonylureas
was higher than we thought, at a rate of
7% per year. Hypoglycaemic events also
increased over time in type 2 diabetes
patients on insulin but remained less
frequent than in type 1 diabetes patients.’
This study used patients’ self-reporting
and biochemical episodes of less than 2.2
mmol/l on continuous glucose monitoring to
determine events over nine to 12 months in
UK secondary care diabetes centres. Insights
from continuous glucose monitoring has
shown that the majority of hypoglycaemic
events occur at night, and in the younger
patient, do not appear to impair cognitive
function, although, the next day, subjective
well being is affected. ‘These nocturnal
events may, however, contribute to the
development of impaired awareness of
hypoglycaemia’, Dr Frier noted.
Age affects hypoglycaemic awareness,
with younger patients being able to tolerate
lower glucose levels without cognitive
dysfunction, while older patients, over
the age of 65 years have less time for
corrective action and generally experience
wider cognitive dysfunction, including
visual disturbances, inco-ordination and
impaired balance.
23
‘These symptoms could
be perceived by the attending physician as a
transient ischaemic attack or early dementia