Hypoglycémie et effets cardiovasculaires

Hypoglycemic events are practically unavoidable when glycemic control is optimized. The contribution of hypoglycemias to the augmentation of cardiovascular mortality in the ACCORD study is not clearly demonstrated. The lag time between hypoglycemic episodes and cardiovascular events is too long to consider these episodes as directly responsible. However several cardiovascular changes, including changes in hemodynamics and ventricular repolarization that involve in particular sympathetic activation may be observed at the time of or immediately after hypoglycemia. Insulin per se, especially in case of vascular insulin resistance, as well as cardiac autonomic neuropathy, may induce similar changes which may occur in addition to those induced by hypoglycemia. In each individual diabetic patient, glycemic target must be defined taking into account the risk of inducing hypoglycemia with its own consequences and the benefit of a better glycemic control.