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Complications
Baseline-Corrected QT (QTc) Interval Is Associated with Prolongation of QTc during Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus
Seon-Ah Cha, Jae-Seung Yun, Tae-Seok Lim, Yoon-Goo Kang, Kang-Min Lee, Ki-Ho Song, Ki-Dong Yoo, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn
Diabetes Metab J. 2016;40(6):463-472.   Published online October 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.463
  • 3,878 View
  • 47 Download
  • 10 Web of Science
  • 10 Crossref
AbstractAbstract PDFPubReader   
Background

We investigated an association between baseline heart rate-corrected QT (QTc) interval before severe hypoglycemia (SH) and prolongation of QTc interval during SH in patients with type 2 diabetes mellitus (T2DM).

Methods

Between January 2004 and June 2014, 208 patients with T2DM, who visited the emergency department because of SH and underwent standard 12-lead electrocardiography within the 6-month period before SH were consecutively enrolled. The QTc interval was analyzed during the incidence of SH, and 6 months before and after SH. QTc intervals of 450 ms or longer in men and 460 ms or longer in women were considered abnormally prolonged.

Results

The mean age and diabetes duration were 68.1±12.1 and 14.1±10.1 years, respectively. The mean QTc intervals at baseline and SH episodes were 433±33 and 460±33 ms, respectively (P<0.001). One hundred and fourteen patients (54.8%) had a prolonged QTc interval during SH. There was a significant decrease in the prolonged QTc interval within 6 months after SH (QTc interval prolongation during SH vs. after recovery, 54.8% vs. 33.8%, P<0.001). The prolonged QTc interval was significantly associated with baseline QTc interval prolongation (odds ratio, 2.92; 95% confidence interval, 1.22 to 6.96; P=0.016) after adjusting for multiple confounders.

Conclusion

A prolonged QTc interval at baseline was significantly associated with prolongation of the QTc interval during SH in patients with T2DM, suggesting the necessity of QTc interval monitoring and attention to those with a prolonged QTc interval to prevent SH.

Citations

Citations to this article as recorded by  
  • Prevalence of QT prolongation and its risk factors in patients with type 2 diabetes
    Khaled Aburisheh, Mohammad F. AlKheraiji, Saleh I. Alwalan, Arthur C. Isnani, Mohamed Rafiullah, Muhammad Mujammami, Assim A. Alfadda
    BMC Endocrine Disorders.2023;[Epub]     CrossRef
  • U-shaped association between the triglyceride–glucose index and atrial fibrillation incidence in a general population without known cardiovascular disease
    Xiao Liu, Ayiguli Abudukeremu, Yuan Jiang, Zhengyu Cao, Maoxiong Wu, Jianyong Ma, Runlu Sun, Wanbing He, Zhiteng Chen, Yangxin Chen, Peng Yu, Wengen Zhu, Yuling Zhang, Jingfeng Wang
    Cardiovascular Diabetology.2023;[Epub]     CrossRef
  • Celebrities in the heart, strangers in the pancreatic beta cell: Voltage‐gated potassium channels Kv7.1 and Kv11.1 bridge long QT syndrome with hyperinsulinaemia as well as type 2 diabetes
    Anniek F. Lubberding, Christian R. Juhl, Emil Z. Skovhøj, Jørgen K. Kanters, Thomas Mandrup‐Poulsen, Signe S. Torekov
    Acta Physiologica.2022;[Epub]     CrossRef
  • Severe hypoglycemia as a risk factor for cardiovascular outcomes in patients with type 2 diabetes: is it preventable?
    Seung-Hyun Ko
    Cardiovascular Prevention and Pharmacotherapy.2022; 4(3): 106.     CrossRef
  • Heart rate-corrected QT interval prolongation is associated with decreased heart rate variability in patients with type 2 diabetes
    Seon-Ah Cha
    Medicine.2022; 101(45): e31511.     CrossRef
  • Severe hypoglycemia as a preventable risk factor for cardiovascular disease in patients with type 2 diabetes mellitus
    Soo-Yeon Choi, Seung-Hyun Ko
    The Korean Journal of Internal Medicine.2021; 36(2): 263.     CrossRef
  • Review of the cardiovascular safety of dipeptidyl peptidase-4 inhibitors and the clinical relevance of the CAROLINA trial
    Marile Santamarina, Curt J. Carlson
    BMC Cardiovascular Disorders.2019;[Epub]     CrossRef
  • Antioxidant effects of epigallocatechin-3-gallate on the aTC1-6 pancreatic alpha cell line
    Ting Cao, Xiong Zhang, Dan Yang, Yue-Qian Wang, Zheng-Dong Qiao, Jian-Ming Huang, Peng Zhang
    Biochemical and Biophysical Research Communications.2018; 495(1): 693.     CrossRef
  • Severe hypoglycemia is a risk factor for atrial fibrillation in type 2 diabetes mellitus: Nationwide population-based cohort study
    Seung-Hyun Ko, Yong-Moon Park, Jae-Seung Yun, Seon-Ah Cha, Eue-Keun Choi, Kyungdo Han, Eugene Han, Yong-ho Lee, Yu-Bae Ahn
    Journal of Diabetes and its Complications.2018; 32(2): 157.     CrossRef
  • Incidence of prolonged QTc and severe hypoglycemia in type 1 diabetes: the EURODIAB Prospective Complications Study
    Cristina Amione, Sara Giunti, Paolo Fornengo, Sabita S. Soedamah-Muthu, Nish Chaturvedi, J. H. Fuller, Federica Barutta, Gabriella Gruden, Graziella Bruno
    Acta Diabetologica.2017; 54(9): 871.     CrossRef
Complications
Severe Hypoglycemia and Cardiovascular or All-Cause Mortality in Patients with Type 2 Diabetes
Seon-Ah Cha, Jae-Seung Yun, Tae-Seok Lim, Seawon Hwang, Eun-Jung Yim, Ki-Ho Song, Ki-Dong Yoo, Yong-Moon Park, Yu-Bae Ahn, Seung-Hyun Ko
Diabetes Metab J. 2016;40(3):202-210.   Published online April 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.3.202
  • 4,749 View
  • 63 Download
  • 49 Web of Science
  • 58 Crossref
AbstractAbstract PDFPubReader   
Background

We investigated the association between severe hypoglycemia (SH) and the risk of cardiovascular (CV) or all-cause mortality in patients with type 2 diabetes.

Methods

The study included 1,260 patients aged 25 to 75 years with type 2 diabetes from the Vincent Type 2 Diabetes Resgistry (VDR), who consecutively enrolled (n=1,260) from January 2000 to December 2010 and were followed up until May 2015 with a median follow-up time of 10.4 years. Primary outcomes were death from any cause or CV death. We investigated the association between the CV or all-cause mortality and various covariates using Cox proportional hazards regression analysis.

Results

Among the 906 participants (71.9%) who completed follow-up, 85 patients (9.4%) had at least one episode of SH, and 86 patients (9.5%) died (9.1 per 1,000 patient-years). Patients who had died were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline, as compared with surviving patients. The experience of SH was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.39 to 5.02; P=0.003) and CV mortality (HR, 6.34; 95% CI, 2.02 to 19.87; P=0.002) after adjusting for sex, age, diabetic duration, hypertension, mean glycosylated hemoglobin levels, diabetic nephropathy, lipid profiles, and insulin use.

Conclusion

We found a strong association between SH and increased risk of all-cause and CV mortality in patients with type 2 diabetes.

Citations

Citations to this article as recorded by  
  • Impaired Awareness of Hypoglycemia and its Risk Factors among Diabetic Patients in Jazan, Saudi Arabia: A Cross-Sectional Study
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    BMC Nephrology.2024;[Epub]     CrossRef
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    Gangfeng Li, Shuping Zhong, Xingmu Wang, Fuyuan Zhuge
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Diabetes mellitus und Straßenverkehr – ein Positionspapier der Österreichischen Diabetesgesellschaft (Update 2023)
    Heidemarie Abrahamian, Birgit Salamon, Angelika Lahnsteiner, Christian Schelkshorn, Alexander Bräuer, Lars Stechemesser, Gerd Köhler, Martin Clodi
    Wiener klinische Wochenschrift.2023; 135(S1): 319.     CrossRef
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    Diana Cristina Henao-Carrillo, Fabio Alexander Sierra-Matamoros, Ana Julia Carrillo Algarra, Julieth Patricia García-Lugo, Sandra Milena Hernández-Zambrano
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2023; 17(12): 102917.     CrossRef
  • Basal insulin analogues in people with diabetes and chronic kidney disease
    David León‐Jiménez, José Pablo Miramontes‐González, Laura Márquez‐López, Francisco Astudillo‐Martín, Luis M. Beltrán‐Romero, Fernando Moreno‐Obregón, Javier Escalada‐San Martín
    Diabetic Medicine.2022;[Epub]     CrossRef
  • Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-based Cohort Study
    Eugene Han, Kyung-do Han, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Seung-Hyun Ko, Yong-ho Lee
    The Journal of Clinical Endocrinology & Metabolism.2022; 107(5): e1976.     CrossRef
  • Validación transcultural del HypoA-Q para medir conciencia de hipoglucemia en pacientes diabéticos
    Ana Julia Carrillo-Algarra, Sandra Milena Hernandez-Zambrano, Fabio Alexander Sierra-Matamoros, Diana Cristina Henao-Carrillo, Ana María Gómez-Medina, Daniel Esteban Hurtado-Barrera
    Revista Ciencia y Cuidado.2022; 19(1): 42.     CrossRef
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    Hyung Jun Kim, Moo-Seok Park, Jee-Eun Kim, Tae-Jin Song
    Annals of Clinical Neurophysiology.2022; 24(1): 7.     CrossRef
  • Severe hypoglycemia as a risk factor for cardiovascular outcomes in patients with type 2 diabetes: is it preventable?
    Seung-Hyun Ko
    Cardiovascular Prevention and Pharmacotherapy.2022; 4(3): 106.     CrossRef
  • Evaluation of a Clinical Platform to Promote Chronic Disease Management
    Laura Greene, Nila Sathe, John A. House, Laura L. Schott, Stella Safo
    Population Health Management.2021; 24(4): 470.     CrossRef
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    Soo-Yeon Choi, Seung-Hyun Ko
    The Korean Journal of Internal Medicine.2021; 36(2): 263.     CrossRef
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    Katharina Mattishent, Yoon K. Loke
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    International Journal of Medicine in Developing Countries.2021; : 614.     CrossRef
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    Jae-Seung Yun, Seung-Hyun Ko
    Metabolism.2021; 123: 154838.     CrossRef
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    Bancha Satirapoj, Thongchai Pratipanawatr, Boonsong Ongphiphadhanakul, Sompongse Suwanwalaikorn, Yupin Benjasuratwong, Wannee Nitiyanant
    BMJ Open.2020; 10(2): e031612.     CrossRef
  • Predictors of Diabetes Self-Care Practice Among Patients with Type 2 Diabetes in Public Hospitals in Northeastern Ethiopia: A Facility-Based Cross-Sectional Study


    Tesfaye Molla Gulentie, Ebrahim Mohammed Yesuf, Taklo Simeneh Yazie, Belayneh Kefale
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 3137.     CrossRef
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    Byron J. Hoogwerf
    Clinics in Geriatric Medicine.2020; 36(3): 395.     CrossRef
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    Francesco Zaccardi, Suping Ling, Claire Lawson, Melanie J. Davies, Kamlesh Khunti
    Diabetologia.2020; 63(10): 2129.     CrossRef
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    Carolina C. Betônico, Silvia Maria O. Titan, Aécio Lira, Tatiana S. Pelaes, Maria Lúcia C. Correa-Giannella, Márcia Nery, Márcia Queiroz
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    Yehuda Handelsman, Christina Chovanes, Terry Dex, Francesco Giorgino, Neil Skolnik, Elisabeth Souhami, William Stager, Elisabeth Niemoeller, Juan Pablo Frias
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    Victor Sokolov, Tatiana Yakovleva, Shinya Ueda, Joanna Parkinson, David W. Boulton, Robert C. Penland, Weifeng Tang
    Diabetes, Obesity and Metabolism.2019; 21(4): 829.     CrossRef
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    Marile Santamarina, Curt J. Carlson
    BMC Cardiovascular Disorders.2019;[Epub]     CrossRef
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    Current Diabetes Reviews.2019; 15(5): 407.     CrossRef
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    Sorin Ioacara, Elisabeta Sava, Olivia Georgescu, Anca Sirbu, Simona Fica
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    D. A. Lebedev, A. Yu. Babenko
    Medical Council.2018; (16): 100.     CrossRef
  • Severe hypoglycemia is a risk factor for atrial fibrillation in type 2 diabetes mellitus: Nationwide population-based cohort study
    Seung-Hyun Ko, Yong-Moon Park, Jae-Seung Yun, Seon-Ah Cha, Eue-Keun Choi, Kyungdo Han, Eugene Han, Yong-ho Lee, Yu-Bae Ahn
    Journal of Diabetes and its Complications.2018; 32(2): 157.     CrossRef
  • Antioxidant effects of epigallocatechin-3-gallate on the aTC1-6 pancreatic alpha cell line
    Ting Cao, Xiong Zhang, Dan Yang, Yue-Qian Wang, Zheng-Dong Qiao, Jian-Ming Huang, Peng Zhang
    Biochemical and Biophysical Research Communications.2018; 495(1): 693.     CrossRef
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    Mee Kyoung Kim, Jee Sun Jeong, Jae-Seung Yun, Hyuk-Sang Kwon, Ki Hyun Baek, Ki-Ho Song, Yu-Bae Ahn, Seung-Hyun Ko
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    Marcello Casaccia Bertoluci, Viviane Zorzanelli Rocha
    Diabetology & Metabolic Syndrome.2017;[Epub]     CrossRef
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  • Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus
    Jae-Seung Yun, Seung-Hyun Ko
    Diabetes & Metabolism Journal.2016; 40(6): 423.     CrossRef
  • Real-world evidence for the safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): final results of a post-marketing surveillance study
    Koutaro Yokote, Yasuo Terauchi, Ichiro Nakamura, Haruko Sugamori
    Expert Opinion on Pharmacotherapy.2016; 17(15): 1995.     CrossRef
  • Hypoglycemia: Culprit or Bystander?
    You-Cheol Hwang
    Diabetes & Metabolism Journal.2016; 40(3): 190.     CrossRef
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    E. Fritschka
    MMW - Fortschritte der Medizin.2016; 158(S3): 46.     CrossRef
Complications
Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes
Jae-Seung Yun, Seung-Hyun Ko, Sun-Hye Ko, Ki-Ho Song, Ki-Dong Yoo, Kun-Ho Yoon, Yong-Moon Park, Yu-Bae Ahn
Diabetes Metab J. 2015;39(6):498-506.   Published online July 8, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.6.498
  • 3,422 View
  • 34 Download
  • 20 Web of Science
  • 21 Crossref
AbstractAbstract PDFPubReader   
Background

To investigate whether a history of prior cardiovascular disease (CVD) is associated with severe hypoglycemia (SH) in patients with type 2 diabetes.

Methods

We conducted a prospective cohort study from January 2001 to December 2012 with a median follow-up time of 9.5 years (5,814 person-years). Patients aged 25 to 75 years with type 2 diabetes and without chronic kidney disease were enrolled (n=894), and 624 patients completed follow-up. SH was defined as hypoglycemic episodes requiring hospitalization or medical care in an emergency department. We used the Cox proportional hazards regression analysis to test associations between SH episodes and potential explanatory variables.

Results

Among the 624 participants who completed follow-up, 60 patients (9.6%) had previous CVD. Compared to patients without CVD, patients with previous CVD were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline. During follow-up, 62 patients (9.9%) experienced at least one SH episode (incidence of 1.33 per 100 patient-years). The development of SH was associated with a history of CVD (hazard ratio, 1.99; 95% confidence interval, 1.07 to 3.72; P=0.031) after adjusting for sex, age, diabetic duration, hypertension, hemoglobin A1c levels, diabetic complications, cardiovascular autonomic neuropathy, and insulin use.

Conclusion

A history of CVD was an independent risk factor for the development of SH in patients with type 2 diabetes mellitus. For patients with CVD, modulation of glycemic targets and diabetic education for the prevention of hypoglycemia should be implemented.

Citations

Citations to this article as recorded by  
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Erratum
Erratum: Author's Name Correction. Diabetic Retinopathy and Endothelial Dysfunction in Patients with Type 2 Diabetes Mellitus
Jae-Seung Yun, Seung-Hyun Ko, Ji-Hoon Kim, Keon-Woong Moon, Yong-Moon Park, Ki-Dong Yoo, Yu-Bae Ahn
Diabetes Metab J. 2013;37(6):488-488.   Published online December 12, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.6.488
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Original Article
Diabetic Retinopathy and Endothelial Dysfunction in Patients with Type 2 Diabetes Mellitus
Jae-Seung Yun, Seung-Hyun Ko, Ji-Hoon Kim, Kun-Woong Moon, Yong-Moon Park, Ki-Dong Yoo, Yu-Bae Ahn
Diabetes Metab J. 2013;37(4):262-269.   Published online August 14, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.4.262
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  • 22 Crossref
AbstractAbstract PDFPubReader   
Background

We investigated the relationship between endothelial dysfunction and diabetic retinopathy (DR) in patients with type 2 diabetes.

Methods

We used a cross-sectional design to examine 167 patients with type 2 diabetes mellitus. All patients underwent biochemical and ophthalmological examination. We assessed endothelial dysfunction by a flow-mediated vasodilation method of the brachial artery. Changes in vasodilation (flow-mediated vasodilatation, %FMD) were expressed as percent change over baseline values.

Results

The mean±standard deviation of patient age was 54.1±8.6 years. The %FMD was significantly lower in patients with DR than without DR. The prevalence of retinopathy decreased across increasing tertiles of %FMD. After adjusting for patients' age, sex, diabetes duration, use of insulin, use of antihypertensive, antiplatelet, and lipid lowering medications, systolic blood pressure, fasting plasma glucose, 2-hour plasma glucose, glycated hemoglobin, and urinary albumin excretion, participants with a reduced %FMD were more likely to have DR (odds ratio, 11.819; 95% confidence interval, 2.201 to 63.461; P=0.004, comparing the lowest and highest tertiles of %FMD).

Conclusion

Endothelial dysfunction was associated with DR, which was most apparent when the endothelial dysfunction was severe. Our study provides insights into the possible mechanism of the influence of endothelial dysfunction on the development of DR.

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