Acute Changes in Plasma Glucose and Cardiovascular Disease in Diabetes

The present echocardiographic study includes 86 participants from three experimental clamp studies; the Hypo-Heart 1 (Study 1), Hypo-Heart 2 (Study 2) and Rapid-Heart (Study 3), including patients with type 1 diabetes (Hypo-Heart 1 and Rapid-Heart), patients with type 2 diabetes (Hypo-Heart 2) and healthy controls (Hypo-Heart 2). Hypo-Heart 1: Inclusion Criteria: * Informed and written consent * Type 1 diabetes diagnosed according to the criteria of the World Health Organization (WHO) * Age 18-70 years * Insulin treatment for ≥3 years Exclusion Criteria: * Arrhythmia diagnosed prior to the screening visit * Implantable cardioverter defibrillator (ICD) or pacemaker at the time of inclusion * Severe heart failure (left ventricular ejection fraction \<25%) * Structural heart disease (Wolf-Parkinson-White syndrome, congenital heart disease, severe valve disease) * Thyroid dysfunction (except for well-regulated eltroxin substituted myxoedema) * Anemia (male: hemoglobin \<8.0; female: hemoglobin \<7.0 mmol/l) Hypo-Heart 2: Inclusion Criteria: Patients with type 2 diabetes * Informed and written consent * Type 2 diabetes diagnosed according to the criteria of the World Health Organization (WHO) * Treatment with insulin * Glycated haemoglobin A1c (HbA1c) ≤58 mmol/mol Inclusion Criteria: Healthy individuals * HbA1c ≤42 mmol/mol * Fasting plasma glucose ≤6.1 mmol/l Exclusion Criteria: Patients with type 2 diabetes * Arrhythmia diagnosed prior to or at the time of inclusion * Implantable cardioverter defibrillator (ICD) or pacemaker at the time of inclusion * Severe heart failure (left ventricular ejection fraction \<25%) * Structural heart disease (Wolf-Parkinson-White syndrome, congenital heart disease, severe valve disease) * Insulin naïve patients with type 2 diabetes * Thyroid dysfunction (except for well-regulated eltroxine substituted myxoedema) * Unable to comply with daily CGM during run-in period * Anemia (male: hemoglobin \< 8.0; female: hemoglobin \< 7.0 mmol/l) Exclusion Criteria: Healthy individuals * Type 1 or type 2 diabetes * Prediabetes (HbA1c \>42 mmol/l and/or fasting plasma glucose \>6.1 mmol/l) * Family history of diabetes (type 1 og type 2 diabetes) * Arrhythmia diagnosed prior to or at the time of inclusion * ICD or pacemaker at the time of inclusion * Severe heart failure (left ventricular ejection fraction \<25%) * Structural heart disease (Wolf-Parkinson-White syndrome, congenital heart disease, severe valve disease) * Thyroid dysfunction (except for well-regulated eltroxine substituted myxoedema) * Anemia (male: hemoglobin \< 8.0; female: hemoglobin \< 7.0 mmol/l) Rapid-Heart: Inclusion criteria - chronic hyperglycaemia cohort * Informed and written consent * Type 1 diabetes * Age ≥18 years * C-peptide negative (\<0.2 nmol/l) * Insulin treatment for ≥1 year * HbA1C ≥63 mmol/mol Inclusion criteria - well-controlled cohort * Informed and written consent * Type 1 diabetes * Age ≥18 years * C-peptide negative (\<0.2nmol/l) * Insulin treatment for ≥1 year * HbA1C ≤53 mmol/mol Exclusion criteria - both cohorts * Arrhythmia diagnosed prior to or at the time of the screening visit * ECG with left or right bundle branch block diagnosed prior to the screening visit. * Implantable cardioverter defibrillator or pacemaker at the time of inclusion * Heart failure diagnosed prior to the screening visit (left ventricular ejection fraction \< 45%) * Structural heart disease (Wolf-Parkinson-White syndrome, congenital heart disease, severe valve disease) * Thyroid dysfunction (except for well-regulated myxoedema) * Anaemia (male: haemoglobin \<8.0 mmol/l; female: haemoglobin \<7.0 mmol/l) * Treatment with anticoagulant or antiplatelet treatment * Bleeding disorder diagnosed prior to the screening visit