Diabetes medication linked to risk of sudden cardiac arrest

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The research, to be presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany, carried a stark warning.

Diabetics who are prescribed antibiotic and antipsychotic drugs, or prokinetics (used to treat nausea and vomiting), are more likely to suffer from a deadly cardiac arrest.

These commonly prescribed drugs are associated with a change in the functioning of the heart’s electrical system, known as QT-prolongation.

QTc-prolonging drugs:

  • Prokinetics – domperidone
  • Antibiotics – macrolides, fluoroquinolones
  • Antipsychotics – haloperidol.

New figures from Diabetes UK show that 4.3 million people are now living with a diagnosis of type 2 diabetes in the UK.

Thus, if any diabetics have been prescribed QTc-prolonging antibiotics, for example, they could be more likely to experience a life-threatening cardiac arrest.

A cardiac arrest occurs when the heart stops pumping blood, which is a leading cause of death.

People who have type 2 diabetes have a two-fold increased risk of a sudden cardiac arrest, researcher Peter Harms, of Amsterdam UMC, said.

Harms and colleagues carried out a study to assess which clinical characteristics in GP records are associated with sudden cardiac arrest and type 2 diabetes, with and without a cardiovascular disease history.

The study involved 3,919 individuals who have type 2 diabetes; 689 had a sudden cardiac arrest in the Dutch region of Noord-Holland from 2010-2019.

Clinical measurements included blood pressure, blood glucose readings, medication used, and medical history for five years prior to sudden cardiac arrest.

Several characteristics were associated with an increased risk of a sudden cardiac arrest in both people with and without a cardiovascular disease history.

Associated risk factors of a sudden cardiac arrest:

  • History of arrhythmias (68 percent increase in risk)
  • Unknown smoking behaviour (40 percent increase in risk)
  • Insulin use (138 percent increase)
  • QTc-prolonging prokinetic medication (66 percent increase in risk).

Diabetics without a history of cardiovascular disease were also at increased risk of cardiac arrest if they had low fasting glucose.

Low fasting glucose (less than 4.5 mmol/mol), the researchers say, is “an indication of too strict glycaemic control”.

This was associated with a 150 percent increased risk of a sudden cardiac arrest.

Other risk factors included: severe hypertension, unhealthy blood fats, and QTc-prolonging medication.

Mr Harms said: “Our results underline the need for GPs to be aware of the hazards of too strict glycaemic control and the prescription of commonly used antibiotics, antipsychotics and prokinetics.”

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