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dc.contributor.authorAdler, Gail Kurr
dc.contributor.authorBonyhay, Istvan
dc.contributor.authorFailing, Hannah
dc.contributor.authorWaring, Elizabeth
dc.contributor.authorDotson, Sarah
dc.contributor.authorFreeman, Roy Lester
dc.date.accessioned2011-03-15T14:30:07Z
dc.date.issued2009
dc.identifier.citationAdler, 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.issn0012-1797en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4741831
dc.description.abstractOBJECTIVE—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.isoen_USen_US
dc.publisherAmerican Diabetes Associationen_US
dc.relation.isversionofdoi:10.2337/db08-1153en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628609/pdf/en_US
dash.licenseLAA
dc.titleAntecedent Hypoglycemia Impairs Autonomic Cardiovascular Functionen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalDiabetesen_US
dash.depositing.authorAdler, Gail Kurr
dc.date.available2011-03-15T14:30:07Z
dash.affiliation.otherHMS^Neurology- Beth Israel-Deaconessen_US
dash.affiliation.otherHMS^Neurology- Beth Israel-Deaconessen_US
dc.identifier.doi10.2337/db08-1153*
dash.contributor.affiliatedBonyhay, Istvan
dash.contributor.affiliatedAdler, Gail
dash.contributor.affiliatedFreeman, Roy


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