Effect of hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with and without type 1 diabetes: a prospective, randomised, open-label, blinded endpoint, cross-over study

Noh, R. M., Graveling, A. J., Lang, N. N. , White, A. C., Lee, K. K., Mills, N. L., Newby, D. E., Lang, C. C. and Frier, B. M. (2021) Effect of hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with and without type 1 diabetes: a prospective, randomised, open-label, blinded endpoint, cross-over study. Endocrinology, Diabetes and Metabolism, 4(3), e00258. (doi: 10.1002/edm2.258)

Abstract

Aims: This study examined the effect of experimentally‐induced hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with, and without, type 1 diabetes. Methods: In a prospective, randomised, open‐label, blinded, endpoint cross‐over study, 17 young adults with type 1 diabetes with no cardiovascular risk factors, and 10 healthy non‐diabetic volunteers, underwent hyperinsulinaemic‐euglycaemic (blood glucose 4.5–5.5 mmol/L) and hypoglycaemic (2.2–2.5 mmol/L) clamps. Myocardial blood flow was assessed using transthoracic echocardiography Doppler coronary flow reserve (CFR) and myocardial injury using plasma high‐sensitivity cardiac troponin I (hs‐cTnI) concentration. Results: During hypoglycaemia, coronary flow reserve trended non‐significantly lower in those with type 1 diabetes than in the non‐diabetic participants (3.54 ± 0.47 vs. 3.89 ± 0.89). A generalised linear mixed‐model analysis examined diabetes status and euglycaemia or hypoglycaemia as factors affecting CFR. No statistically significant difference in CFR was observed for diabetes status (p = .23) or between euglycaemia and hypoglycaemia (p = .31). No changes in hs‐cTnI occurred during hypoglycaemia or in the recovery period (p = .86). Conclusions: A small change in CFR was not statistically significant in this study, implying hypoglycaemia may require more than coronary vasomotor dysfunction to cause harm. Further larger studies are required to investigate this putative problem.

• Item Type: Articles
• Additional Information: The study was funded by the Scottish Chief Scientist Office (Grant number CZB/4/721). DEN is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/18/5/34216) and a Wellcome Trust Senior Investigator Award (WT103782AIA).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lang, Professor Ninian
• Authors: Noh, R. M., Graveling, A. J., Lang, N. N., White, A. C., Lee, K. K., Mills, N. L., Newby, D. E., Lang, C. C., and Frier, B. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Endocrinology, Diabetes and Metabolism
• Publisher: Wiley
• ISSN: 2398-9238
• ISSN (Online): 2398-9238
• Published Online: 07 May 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Endocrinology, Diabetes and Metabolism 4(3): e00258
• Publisher Policy: Reproduced under a Creative Commons License