Risk stratification of cardiac arrhythmias and sudden cardiac death in type 2 diabetes mellitus patients receiving insulin therapy: A population-based cohort study - PubMed
Source : https://pubmed.ncbi.nlm.nih.gov/34545599/
HbA1c and lipid variability were predictive of SCD. Therefore, poor glucose control and variability in lipid parameters in diabetic patients are associated with aborted or actual SCD. These observations suggest the need to re-evaluate the extent of glycemic control required for outcome optimization.
Conclusion: HbA1c and lipid variability were predictive of SCD. Therefore, poor glucose control and variability in lipid parameters in diabetic patients are associated with aborted or actual SCD. These observations suggest the need to re-evaluate the extent of glycemic control required for outcome optimization.
• Conclusion/Relevance: “Poor glucose control and variability in lipid parameters in diabetic patients are associated with SCD [sudden cardiac death]. These observations suggest the need to re-evaluate the extent of glycemic control required for outcome optimization. Further studies on the predictive value of variability in other glycemic measures, such as fasting and random blood glucose, in addition to other methods of measuring variability, should be performed to further examine the predictiveness of glycemic variability towards arrhythmias in diabetic patients.”
• In the current retrospective study, researchers assessed the predictive value of HbA1c and lipid variability on the risks of SCD and incident atrial fibrillation (AF) in 23,329 patients from Hong Kong.
• Here are the major findings from the study: (1) Clinical and biochemical indices predicted arrhythmic occurrence in those with diabetes; (2) mean/variability of and lipid indices predicted VT/VF/SCD in study participants; (3) HbA1c variability was correlated with hypoglycemia frequency.
• The prognostic potential of HbA1c and lipid variability have been a focus of research in recent years. Most studies, however, have investigated the relationships to all-cause mortality or cardiovascular events., with few looking at arrhythmic or SCD outcomes.
• Chronic hyperglycemia can lead to structural remodeling, with HbA1c variability linked to atrial and ventricular remodeling and fibrosis, which could predispose to arrhythmias.
• “Similar to glycemic variability, the increase in oxidative stress with fluctuations in lipid levels due to atherogenic substance release from unstable plaque is hypothesized to underlie the increased arrhythmic risk,” wrote the authors.
• The authors noted that this study is the first to report a relationship between increased variability in HbA1c and lipid markers with increased risk for VT/VF/SCD in those with diabetes.
• Limitations of the current study are that it was limited to patients with type 2 diabetes who were prescribed insulin, which indicates advanced disease. Furthermore, the observational nature of the study entailed missing data, coding errors, and under-coding.