Post-ICU hypoglycemia is common in insulin-treated T2D

  • Ali Abdelhamid Y & al.
  • Crit Care Med
  • 12 Feb 2021

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • CGM accuracy was at low values, time lag.
  • Glucose change rate, dietary intake effects were not examined.
  • Arrhythmic beats were infrequent.