- After ICU discharge, patients with insulin-treated type-2 diabetes (T2D) frequently experience hypoglycemia that is predominantly nocturnal, asymptomatic, and prolonged.
Why this matters
- Limited data are available about glycemia in patients discharged from ICU or the relationship between glycemia and cardiac complications in survivors of critical illness.
- Prospective, observational, 2-center study of 30 patients with insulin-treated T2D, followed for 101 hours after ICU discharge.
- Simultaneous ambulatory ECG and continuous glucose monitor (CGM) recordings obtained during hypoglycemia (≤3.5 mmol/L), hyperglycemia (≥15 mmol/L), and euglycemia (5-10 mmol/L) for 44, 757, and 991 hours, respectively.
- Funding: Australian and New Zealand Intensive Care Foundation; others.
- 12 participants (39%) experienced ≥1 hypoglycemia episode.
- 78% (40/51 hours) were nocturnal.
- 86% (25/29 episodes) were asymptomatic.
- 5.24% total monitoring time in hypoglycemia.
- Nadir ≤2.2 mmol/L in 34% of episodes.
- All but 1 participant (97%) experienced ≥1 hyperglycemia episode, 76% during daytime (672/817 hours).
- Bradycardia was more frequent during hypoglycemia (incident rate ratio, 24; P<.001>
- No difference between hypoglycemia and euglycemia in QT-interval duration, heart rate variability.
- CGM accuracy was at low values, time lag.
- Glucose change rate, dietary intake effects were not examined.
- Arrhythmic beats were infrequent.