Poor Glycaemic Control and Arrhythmias

• Published in: Endocrine research Vol. 38; no. 4; pp. 206 - 214
• Main Authors: Arnò, Raffaella, Bastagli, Luciana, Martignani, Cristian
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01.01.2013; Taylor & Francis
• Subjects: Aged; Aged, 80 and over; Arrhythmias, Cardiac - blood; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - physiopathology; Blood Glucose - analysis; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Hyperglycaemia; Hypoglycaemia; Male; Retrospective Studies
• ISSN: 0743-5800; 1532-4206
• DOI: 10.3109/07435800.2013.767268

Objective. To evaluate number, type, and complexity of arrhythmias in diabetics compared with controls and, among diabetics, comparing good glycaemic control (GGC) and poor glycaemic control (PGC) patients. Methods. We compared Ambulatory Electrocardiogram recordings of 92 diabetics and 100 controls. The glycaemic profile of 50 diabetics, taken the same day as the Ambulatory ECG recording, was subdivided into GGC (gluco-stick mean values between 100 and 140 mg/dL) or PGC (gluco-stick values ≤99 mg/dL in 3-of-4 daily determination or gluco-stick values ≥140 mg/dL in 3-of-4 daily determination). Results. Diabetics show a higher prevalence of either ventricular ectopic beats (VEBs) (93.47% vs. 82% controls, p < 0.05) and heart rate (both in sinus rhythm and in atrial fibrillation) (98.35 ± 10 beats/min in diabetics vs. 78.10 ± 8.1 in controls, p < 0.001). Moreover, diabetics with PGC show either a higher prevalence of VEBs (96.42% vs 77.27% in GGC, p < 0.05) and of supraventricular ectopic beats (SVEBs) (96.42% vs. 68.18 in GGC, p < 0.05); furthermore, diabetics with PGC show more severe and complex atrial and ventricular arrhythmias (SVEBs 32.14% vs 0%, p < 0.05; VEBs 39.28% vs 9.09%, p < 0.05). Conclusions. The analysis of our sample shows that the arrhythmogenic condition is not only provided from diabetic condition per se but it is enhanced in PGC. Infact PGC patients showed higher number of VEBs, often polymorphic, expression of more severe arrhythmic and cardiovascular outcome. This could be partially explained by hyperactivation of autonomic nervous system during metabolic stress (which increases mean heart rate). Moreover more severe diabetic patients may present coronary microangiopathy that can further explain their arrhythmogenic tendency.