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EASD: Frequent Hypoglycemia Key in Cardiac Risk

Posted: Sunday, October 03, 2010

Patients with Type 1 diabetes who have repeated episodes of hypoglycemia appear to be at risk for early signs of atherosclerosis, researchers said.

According to Montserrat Gimenez, MD, of Hospital Clinic of Barcelona in Spain, and colleagues, those who had frequent bouts of low blood sugar were more likely to have early markers of vascular disease, including increased leukocytes, fibrinogen, and intima-media thickness (P<0.05).

Diabetes has long been associated with an increased risk of atherosclerosis and heart disease, even though many patients lack classical cardiovascular risks. And recent studies have shown that intense glucose control may also be associated with cardiovascular disease.

But the role of frequent hypoglycemia in heart and vascular disease in diabetes is still unclear. So the researchers looked at 25 patients with Type 1 diabetes who had more than four mild to moderate hypoglycemia episodes a week and about two severe episodes in the preceding year. These patients had no other complications or autonomic dysfunction.

They were compared with 20 patients who didn't have frequent hypoglycemic episodes (fewer than two per week and no serious hypoglycemia). These controls were also free of other complications or autonomic dysfunction.

Gimenez and colleagues assessed inflammation and endothelial markers -- including leukocytes, Von Willebrand factor, fibrinogen, and ICAM-1 -- as well as flow-mediated dilation in the brachial artery and intima-media thickness at both the carotid and femoral arteries.

They found that those with frequent hypoglycemic episodes generally had a worse atherosclerosis profile.

For instance, the percentage of maximal flow-mediated dilation was lower in this group than among controls (6.52% versus 8.62%, P<0.05).

They also had significantly higher intima-media thickness at both the carotid and femoral arteries, compared with controls (0.53 mm versus 0.47 mm, P<0.05 for the carotid artery, 0.51 mm versus 0.39 mm, P<0.05, for the femoral).

Markers of inflammation and endothelial dysfunction -- leukocytes, Von Willebrand, fibrinogen, and ICAM-1 -- were also higher among patients with frequent hypoglycemia (P<0.05 for all).

When looking for atherosclerotic plaques, the researchers found them in 10 of the 25 frequently hypoglycemic patients, but in none of the controls.

In addition, few of the patients with frequent hypoglycemia knew they were experiencing such episodes, as measured by both Clarke's test and by Edinburgh's scale, the researchers reported.

They cautioned that the exact mechanism underlying the relationship between diabetes and heart disease is still unclear and needs further research in order to be clarified.

Source:, Gimenez M, et al "Repeated episodes of hypoglycaemia aggravate preclinical atherosclerosis in a group of young adult subjects with Type 1 diabetes" EASD 2010; Abstract 14.

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