Glycopenia - induced sympathoadrenal activation in diabetes mellitus and uncontrolled arterial hypertension: an observat
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abetology & Metabolic Syndrome Open Access
RESEARCH
Glycopenia ‑ induced sympathoadrenal activation in diabetes mellitus and uncontrolled arterial hypertension: an observational study Abimbola Abobarin‑Adeagbo1, Andreas Wienke2, Matthias Girndt1 and Rainer U. Pliquett1,3*
Abstract Background: Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hyper‑ tension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypo‑ glycemic episodes than their counterparts without hypertensive crisis on admission. Methods: In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous glucose monitoring, 24-h blood-pressure- and Holter electrocardiogram record‑ ings, and to laboratory tests including plasma catecholamines. Results: 53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher bodymass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more docu‑ mented hypoglycemic episodes (0.8 ± 0.5 per 24 h) than Group-2 patients (0.2 ± 0.3 per 24 h), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 h). Plasma norepinephrine and mean arterial blood pressure were higher Group-1 and Group-3 patients than in control patients of Group 2. At discharge, the daily cumulative insulin dose was reduced in Group-1 (− 18.4 ± 24.9 units) and in Group-3 patients (− 18.6 ± 22.7 units), but remained unchanged in Group-2 control patients (− 2.9 ± 15.6 units). Conclusions: An association between hypoglycemic events and uncontrolled hypertension was found in this study. Keywords: Arterial hypertension, Norepinephrine, Hypoglycemia, Diabetes mellitus Background Randomized clinical trials have proven that the use of intensive insulin therapy to target normal glycated hemoglobin A1c (HbA1c) did not offer cardiovascular benefits [1] and have been shown to even increase the cardiovascular mortality for type-2-diabetes patients [2]. The reason for this lack of benefit or even excess mortality seen, *Correspondence: [email protected] 1 Department of Internal Medicine II, Martin-Luther-Universität HalleWittenberg, Universitätsklinikum Halle, Ernst‑Grube‑Str. 40, 06120 Halle (Saale), Germany Full list of author information is available at the end of the article
may relate to hypoglycemia, which correlates with the occurrence of ventricular arrhythmias [3] and bradycardia [4]. Although hypoglycemic events occurred less frequently in type-2- than in type-1 diabetics, the related mortality risk was higher for type-2 d
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