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Managing Hyperinsulinemia to Reduce Weight Gain and Hypoglycemia Risk: Implications for Cardiovascular Health

Explore the repercussions of hyperinsulinemia, weight gain, and hypoglycemia on cardiovascular health. Learn about prolonged QT intervals, arrhythmias, and increased mortality risks associated with these conditions. Discover optimal glucose management goals recommended by ADA and AACE for different patient groups, considering risks of hypoglycemia and weight gain. Understand the importance of early intervention and tailored approaches in preventing and managing metabolic syndrome and impaired glucose tolerance.

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Managing Hyperinsulinemia to Reduce Weight Gain and Hypoglycemia Risk: Implications for Cardiovascular Health

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  1. Vicious Circle(s) of Hyperinsulinemia-Result in Weight Gain and Hypoglycemia Undue Or bolus Hypoglycemia Symptomatic or not!

  2. Consequences of Hypoglycemia • Prolonged QT- intervals- Diabetologia 52:42,2009 • Can be of pronged duration IJCP Sup 129, 7/02 • Greater with higher catecholamine levels Europace 10,860 • Associated with Angina Diabetes Care 26, 1485, 2003 / Ischemic EKG changes Porcellati, ADA2010 • Associated with Arrhythmias • Associated with Sudden Death Endocrine Practice 16,¾ 2010 • Increased Variabilty- explains highest mortality in intensive group had highest HgA1c in ACCORD ( increases inflammation, ICU mortality Hirsch ADA2010)

  3. So given epidemiologic data, CV risk/glucose data and now ADVANCE, VADT, ACCORD, implications of weight gain and hypogycemia, what are/ should be goals (SSS) • 1. ADA- stayed at <7.0 • AACE – stayed at < 6.5 • Lowest possible as long as no undue risk of • hypoglycemia and visceral weight gain • 2. ADA and AACE- • Start early in DM - • implications for prevention- • lifestyle and drug therapy of metabolic syndrome and IGT • b. do not aim for aggressive control in those • with significant pre-existing CV disease • Disagree- lowest possible without hypoglycemia, weight gain • Modify goals for ‘elderly’ • Disagree- lowest possible without hypoglycemia, weight gain

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