title: Low glucose blood levels are associated with abnormal cardiac sympatho-vagal balance in type 2 diabetic patients with coronary artery disease.
abstract: OBJECTIVE
  Glycemic control has been suggested to improve prognosis in diabetic patients, but recent trials failed to show benefits from intensive glycemic control. Hypoglycaemic episodes or large variability in glucose blood levels causing a sympatho-vagal imbalance of cardiac autonomic function (CAF) might play a role in this result. In our study we assessed whether blood glucose fluctuation may be related to variations in CAF during daily life in diabetic patients with coronary artery disease (CAD).
  
  
  METHODS
  Twelve patients with type 2 diabetes mellitus with CAD (65+/-4 years, 2 women) underwent simultaneous 48-hour ECG Holter monitoring and continuous interstitial glucose measurements. The highest and lowest glucose levels for each 3-hour segments of the day were identified and heart rate variability (HRV) parameters were measured on Holter recordings on 5-minute intervals centred on these times.
  
  
  RESULTS
  Overall, 294 glucose levels were available for analysis. In the whole population several HRV indices were significantly lower in correspondence of the lowest glucose blood levels and this difference was much more evident in patients who were not taking beta-blockers, than in patients who were taking beta-blockers. A significant, although mild, correlation was found between glucose blood levels and several time-and frequency domain HRV variables in patients not taking beta-blockers, but not in these on beta-blockers therapy.
  
  
  CONCLUSIONS
  Our data suggest that, in type 2 diabetic patients with CAD, hypoglycaemic episodes are associated with depressed HRV and that beta-blocking agents are able to contrast this relation. These interesting results merit to be investigated in a larger population of patients.
authors.affiliation: Institute of Cardiology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Infusino
authors.forename: D
authors.initials: D
authors.lastname: Pitocco
authors.forename: F
authors.initials: F
authors.lastname: Zaccardi
authors.forename: G
authors.initials: G
authors.lastname: Scalone
authors.forename: I
authors.initials: I
authors.lastname: Coviello
authors.forename: R
authors.initials: R
authors.lastname: Nerla
authors.forename: R
authors.initials: R
authors.lastname: Mollo
authors.forename: A
authors.initials: A
authors.lastname: Sestito
authors.forename: A
authors.initials: A
authors.lastname: Di Monaco
authors.forename: L
authors.initials: L
authors.lastname: Barone
authors.forename: C
authors.initials: C
authors.lastname: Pisanello
authors.forename: G
authors.initials: G
authors.lastname: Ghirlanda
authors.forename: G A
authors.initials: GA
authors.lastname: Lanza
authors.forename: F
authors.initials: F
authors.lastname: Crea
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002940:Circadian Rhythm; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose