BACKGROUND: Several studies have suggested that the occurrence of severe hypoglycemia during sleep may be more dangerous for cardiac arrhythmia than that in the day-time. METHODS: We performed a retrospective study between January 2006 and March 2012 to assess electrocardiograms during severe hypoglycemia in patients with or without diabetes. RESULTS: A total of 59,602 patients who visited the emergency room by ambulance were screened, and 287 patients with severe hypoglycemia were enrolled. The median blood glucose levels in patients with (DM, n = 192) and without diabetes (non-DM, n = 95) were 30 and 45 mg/dL, respectively. During severe hypoglycemia, the incidence of abnormal QT prolongation was significantly higher in the early morning (4-10 a.m.) than at other times (DM group, 74.3% versus 54.1%, P = 0.02; non-DM group, 78.3% versus 50.0%, P = 0.01). Multivariate logistic regression analysis identified the occurrence of severe hypoglycemia in the early morning as a strong factor for abnormal QT prolongation (DM group, odds ratio [OR] 2.80, 95% confidence interval [CI] 1.15-6.80, P = 0.02; non-DM group, OR 4.53, 95% CI 1.30-15.74, P = 0.01). CONCLUSIONS: The incidence of abnormal QT prolongation during severe hypoglycemia was significantly higher in the early morning than at all other times, independent of the cause of severe hypoglycemia.
BACKGROUND: Several studies have suggested that the occurrence of severe hypoglycemia during sleep may be more dangerous for cardiac arrhythmia than that in the day-time. METHODS: We performed a retrospective study between January 2006 and March 2012 to assess electrocardiograms during severe hypoglycemia in patients with or without diabetes. RESULTS: A total of 59,602 patients who visited the emergency room by ambulance were screened, and 287 patients with severe hypoglycemia were enrolled. The median blood glucose levels in patients with (DM, n = 192) and without diabetes (non-DM, n = 95) were 30 and 45 mg/dL, respectively. During severe hypoglycemia, the incidence of abnormal QT prolongation was significantly higher in the early morning (4-10 a.m.) than at other times (DM group, 74.3% versus 54.1%, P = 0.02; non-DM group, 78.3% versus 50.0%, P = 0.01). Multivariate logistic regression analysis identified the occurrence of severe hypoglycemia in the early morning as a strong factor for abnormal QT prolongation (DM group, odds ratio [OR] 2.80, 95% confidence interval [CI] 1.15-6.80, P = 0.02; non-DM group, OR 4.53, 95% CI 1.30-15.74, P = 0.01). CONCLUSIONS: The incidence of abnormal QT prolongation during severe hypoglycemia was significantly higher in the early morning than at all other times, independent of the cause of severe hypoglycemia.
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Keywords:
Arrhythmia; QT prolongation; diabetes; nocturnal hypoglycemia; severe hypoglycemia