Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

被引:63
作者
Murphy, NP
Ford-Adams, ME
Ong, KK
Harris, ND
Keane, SM
Davies, C
Ireland, RH
Macdonald, IA
Knight, EJ
Edge, JA
Heller, SR
Dunger, DB
机构
[1] Univ Cambridge, Addenbrookes Hosp, Dept Paediat, Cambridge CB2 2QQ, England
[2] Univ Oxford, Dept Paediat, Oxford OX1 2JD, England
[3] Univ Bath, Dept Med Sci, Bath BA2 7AY, Avon, England
[4] Univ Sheffield, Ctr Clin Sci, Sheffield S10 2TN, S Yorkshire, England
[5] Univ Nottingham, Queens Med Ctr, Dept Physiol, Nottingham NG7 2RD, England
基金
英国惠康基金;
关键词
child; hypoglycaemia; hypokalaemia; QT interval; type; 1; diabetes;
D O I
10.1007/s00125-004-1552-y
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis. It has been postulated that hypoglycaemia-related cardiac dysrhythmia and, in particular, prolonged cardiac repolarisation, may contribute to increased mortality rates in children and adolescents with type I diabetes. Methods. We examined the prevalence of prolonged QT interval on ECG during spontaneous hypoglycaemia in 44 type I diabetic subjects (aged 7-18 years), and explored the relationships between serial overnight measurements of QT interval corrected for heart rate (QTc) and serum glucose, potassium and epinephrine levels. Each subject underwent two overnight profiles; blood was sampled every 15 min for glucose measurements and hourly for potassium and epinephrine. Serial ECGs recorded half-hourly between 23.00 and 07.00 hours were available on 74 nights: 29 with spontaneous hypoglycaemia (defined as blood glucose <3.5 mmol/l) and 45 without hypoglycaemia. Results. Mean overnight QTc was longer in females than in males (412 vs 400 ms, p=0.02), but was not related to age, diabetes duration or HbA(1)c. Prolonged QTc (>440 ms) occurred on 20 out of 74 (27%) nights, with no significant differences between male and female subjects, and was more prevalent on nights with hypoglycaemia (13/29, 44%) than on nights without (7/45, 15%, p=0.0008). Potassium levels were lower on nights when hypoglycaemia occurred (minimum potassium 3.4 vs 3.7 mmol/l, p=0.0003) and were inversely correlated with maximum QTc (r=-0.40, p=0.03). In contrast, epinephrine levels were not higher on nights with hypoglycaemia and were not related to QTc. Conclusions/interpretation. In young type I diabetic subjects, prolonged QTc occurred frequently with spontaneous overnight hypoglycaemia and may be related to insulin-induced hypokalaemia.
引用
收藏
页码:1940 / 1947
页数:8
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