Article Sidebar

Submitted
Jun 13, 2022
Accepted
Sep 2, 2022
Published
Oct 2, 2022
Download
PDF
Statistic
Read Counter : 631 Download : 4621

Main Article Content

Abstract

Background: Cardiovascular disease is the most common cause of morbidity and mortality in diabetic patients. Patients with Diabetes Mellitus (DM) often require insulin therapy to control hyperglycemia, yet, it is associated with the risk of hypokalemia and dysrhythmia. Objectives: To evaluate the prevalence and the risk of hypokalemia and arrhythmia due to insulin therapy in DM patients with Coronary Heart Disease (CHD) comorbidity. Material and Methods: The study was conducted retrospectively based on medical record data from January 2021 to December 2021 in Wahidin Sudirohusodo general hospital. The inclusion criteria include the out-hospital patients diagnosed with DM with CHD comorbidity. The patients were divided into 2 groups, those who received insulin and those who received oral antidiabetic drugs (OAD). Hypokalemia was defined if an electrolyte characterized by a low serum potassium concentration with a normal range of 3.5 – 5.0 mEq/L. Arrhythmia was defined if abnormal changes in a regular heartbeat, including an irregular heartbeat, a skipped heartbeat, a fast heart rate (tachycardia), or a slow heart rate (bradycardia). Results: The data were obtained from 322 patients’ medical record, 161 was treated with insulin, and 161 received OAD. The insulin-treated patients had a significantly lower blood potassium level compared to the OAD group. The insulin group had 63,40% incidents of hypokalemia, while in the OAD group only  16,80% experienced hypokalemia (p<0.05). The presence of arrhythmia was detected in 63,40 % of insulin-treated patients, while only 29,80% had arrhythmia in the OAD group (p<0,05). Conclusions: Insulin Therapy in DM patients with coronary heart disease can increase the incidence of hypokalemia, which may result in arrhythmia in patients with coronary heart disease.

Keywords

Hypokalemia Insulin Arrhytmia Diabetes Mellitus Coronary Heart Disease.

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

How to Cite
Tajuddin, H., Wahyudin, E., Djabir, Y. Y., Nainu, F., & Rahman, L. (2022). Insulin Therapy Increases the Risk of Hypokalemia and Arrhythmia in Diabetic Patients with Coronary Heart Disease: A Retrospective Study in Wahidin Sudirohusodo General Hospital: Terapi Insulin Meningkatkan Risiko Hipokalemia dan Aritmia pada Penderita Diabetes dengan Penyakit Jantung Koroner: Studi Retrospektif di RSU Wahidin Sudirohusodo. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal), 8(2), 97-108. https://doi.org/10.22487/j24428744.2022.v8.i2.15930

References

  1. Al-Nohair, S., Babiker, N., Al-Ahmari, D., Al-Mutairi, D., Al-Matroudi, K., Al-Mutairi, Z., Al-Ahmdi, R., Al-Mufadhi, L., Al-Wahiby, A., & Alharbi, T. (2020). Cross-sectional study of cardiovascular risk factors among male and female medical students in qassim university – college of medicine saudi arabia. Open Access Macedonian Journal of Medical Sciences, 8(E), 439–445. https://doi.org/10.3889/oamjms.2020.4501
  2. Andersen, A., Bagger, J. I., Baldassarre, M. P. A., Christensen, M. B., Abelin, K. U., Faber, J., Pedersen-Bjergaard, U., Holst, J. J., Lindhardt, T. B., Gislason, G., Knop, F. K., & Vilsbøll, T. (2021). Acute hypoglycemia and risk of cardiac arrhythmias in insulin-treated type 2 diabetes and controls. European Journal of Endocrinology, 185(2), 343–353. https://doi.org/10.1530/EJE-21-0232
  3. Barbosa, T. C., Kaur, J., Holwerda, S. W., Young, C. N., Curry, T. B., Thyfault, J. P., Joyner, M. J., Limberg, J. K., & Fadel, P. J. (2018). Insulin increases ventilation during euglycemia in humans. American Journal of Physiology - Regulatory Integrative and Comparative Physiology, 315(1), R84-R89,. https://doi.org/10.1152/ajpregu.00039.2018
  4. Bösenberg, L. H., & Van Zyl, D. G. (2008). The mechanism of action of oral antidiabetic drugs: A review of recent literature. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 13(3), 80–89. https://doi.org/10.1080/22201009.2008.10872177
  5. Cersosimo, E., & DeFronzo, R. A. (2006). Insulin resistance and endothelial dysfunction: The road map to cardiovascular diseases. Diabetes/Metabolism Research and Reviews, 22(6), 423–436. https://doi.org/10.1002/dmrr.634
  6. David, I., & Wingo, S. (1997). Hypokalemia-Consequences Causes. Journal of the American Society of Nephrology, 8(7), 1179–1188.
  7. Dunlay, S. M., Givertz, M. M., Aguilar, D., Allen, L. A., Chan, M., Desai, A. S., Deswal, A., Dickson, V. V., Kosiborod, M. N., Lekavich, C. L., McCoy, R. G., Mentz, R. J., & Piña, I. L. (2019). Type 2 diabetes mellitus and heart failure a scientific statement from the American Heart Association and the Heart Failure Society of America. In Circulation (Vol. 140, Issue 7). https://doi.org/10.1161/CIR.0000000000000691
  8. Kardalas, E., Kardalas, E., Paschou, S. A., Anagnostis, P., Muscogiuri, G., & Siasos, G. (2018). Hypokalemia : a clinical update. Endocrine Connections, 7(2), 135–146.
  9. Lehrke, M., & Marx, N. (2017). Diabetes Mellitus and Heart Failure. American Journal of Cardiology, 120(1), S37–S47. https://doi.org/10.1016/j.amjcard.2017.05.014
  10. Liamis, G. (2014). Diabetes mellitus and electrolyte disorders. World Journal of Clinical Cases, 2(10), 488. https://doi.org/10.12998/wjcc.v2.i10.488
  11. Ministry of Health RI Agency for Development. (2019). Report of South Sulawesi Province RISKESDAS 2018. In the Agency for Health Research and Development (Vol. 110, Issue 9). http://ejournal2.litbang.kemkes.go.id/index.php/lpb/article/view/3658
  12. Murphy, E. (2011). Estrogen signaling and cardiovascular disease. Circulation Research, 109(6), 687–696. https://doi.org/10.1161/CIRCRESAHA.110.236687
  13. PERKENI. (2021). Practical Guidelines for Insulin Therapy in Diabetes Mellitus Patients 2021. Pb Perkeni, 32–39.
  14. Persson, S. U. (2007). Blood pressure reactions to insulin treatment in patients with type 2 diabetes. International Journal of Angiology, 16(4), 135–138. https://doi.org/10.1055/s-0031-1278267
  15. Salvetti, A., Brogi, G., Di Legge, V., & Bernini, G. P. (1993). The Inter-Relationship between Insulin Resistance and Hypertension. Drugs, 46(2), 149–159. https://doi.org/10.2165/00003495-199300462-00024
  16. Skogestad, J., & Aronsen, J. M. (2018). Hypokalemia-induced arrhythmias and heart failure: New insights and implications for therapy. Frontiers in Physiology, 9(NOV), 1–11. https://doi.org/10.3389/fphys.2018.01500
  17. Zhou, M. S., Wang, A., & Yu, H. (2014). Link between insulin resistance and hypertension: What is the evidence from evolutionary biology? Diabetology and Metabolic Syndrome, 6(1), 1–8. https://doi.org/10.1186/1758-5996-6-12