Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function

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Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function

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dc.contributor.author Failing, Hannah
dc.contributor.author Waring, Elizabeth
dc.contributor.author Dotson, Sarah
dc.contributor.author Adler, Gail Kurr
dc.contributor.author Bonyhay, Istvan
dc.contributor.author Freeman, Roy Lester
dc.date.accessioned 2011-03-15T14:30:07Z
dc.date.issued 2009
dc.identifier.citation Adler, Gail K., Istvan Bonyhay, Hannah Failing, Elizabeth Waring, Sarah Dotson, and Roy Freeman. 2009. Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function. Diabetes 58(2): 360-366. en_US
dc.identifier.issn 0012-1797 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4741831
dc.description.abstract OBJECTIVE—Glycemic control decreases the incidence and progression of diabetic complications but increases the incidence of hypoglycemia. Hypoglycemia can impair hormonal and autonomic responses to subsequent hypoglycemia. Intensive glycemic control may increase mortality in individuals with type 2 diabetes at high risk for cardiovascular complications. We tested the hypothesis that prior exposure to hypoglycemia leads to impaired cardiovascular autonomic function. RESEARCH DESIGN AND METHODS—Twenty healthy subjects (age 28 ± 2 years; 10 men) participated in two 3-day inpatient visits, separated by 1–3 months. Autonomic testing was performed on days 1 and 3 to measure sympathetic, parasympathetic, and baroreflex function. A 2-h hyperinsulinemic [hypoglycemic (2.8 mmol/l) or euglycemic (5.0 mmol/l)] clamp was performed in the morning and in the afternoon of day 2. RESULTS—Comparison of the day 3 autonomic measurements demonstrated that antecedent hypoglycemia leads to 1) reduced baroreflex sensitivity (16.7 ± 1.8 vs. 13.8 ± 1.4 ms/mmHg, P = 0.03); 2) decreased muscle sympathetic nerve activity response to transient nitroprusside-induced hypotension (53.3 ± 3.7 vs. 40.1 ± 2.7 bursts/min, P < 0.01); and 3) reduced (P < 0.001) plasma norepinephrine response to lower body negative pressure (3.0 ± 0.3 vs. 2.0 ± 0.2 nmol/l at −40 mmHg). CONCLUSIONS— Baroreflex sensitivity and the sympathetic response to hypotensive stress are attenuated after antecedent hypoglycemia. Because impaired autonomic function, including decreased cardiac vagal baroreflex sensitivity, may contribute directly to mortality in diabetes and cardiovascular disease, our findings raise new concerns regarding the consequences of hypoglycemia. en_US
dc.language.iso en_US en_US
dc.publisher American Diabetes Association en_US
dc.relation.isversionof doi:10.2337/db08-1153 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628609/pdf/ en_US
dash.license LAA
dc.title Antecedent Hypoglycemia Impairs Autonomic Cardiovascular Function en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal Diabetes en_US
dash.depositing.author Adler, Gail Kurr
dc.date.available 2011-03-15T14:30:07Z
dash.affiliation.other HMS^Neurology- Beth Israel-Deaconess en_US
dash.affiliation.other HMS^Neurology- Beth Israel-Deaconess en_US

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