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Heart 100:21-27 doi:10.1136/heartjnl-2013-303871
  • Review

Intensive glucose control and hypoglycaemia: a new cardiovascular risk factor?

  1. Kim Greaves3
  1. 1Department of Cardiology, University of Southampton and Southampton University Hospitals NHS Foundation Trust, Southampton, Hampshire, UK
  2. 2Nutrition & Metabolism Unit, Faculty of Medicine, Institute for Developmental Sciences, University of Southampton and Southampton University Hospitals NHS Foundation Trust, Southampton General Hospital, Southampton, Hampshire, UK
  3. 3Department of Cardiology, Poole Hospital NHS Foundation Trust and Bournemouth University, Poole, Dorset, UK
  1. Correspondence to Professor Kim Greaves, Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK; kimickc{at}yahoo.co.uk
  • Received 25 February 2013
  • Revised 15 April 2013
  • Accepted 19 April 2013
  • Published Online First 22 May 2013

Abstract

Intensive glucose control is widely practiced in patients with diabetes mellitus and patients acutely admitted to hospitals with concomitant stress-induced hyperglycaemia. Such a strategy increases the risk of hypoglycaemia by several-fold. Hypoglycaemia leads to a surge in catecholamine levels with a profound haemodynamic response. In patients with a decreased cardiac reserve, such significant changes can culminate in serious or even fatal cardiovascular outcomes. This review is aimed at discussing in depth the evidence to date that links hypoglycaemia with cardiovascular mortality, reviewing the likely mechanisms underlying this association, as well as summarising these from a cardiologist's perspective.