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Hypoglycaemia and Cardiac Arrhythmias in Type 1 Diabetes Mellitus: A Mechanistic Review

Kyriaki Mavromoustakou1, Christos Fragoulis1, Kyriaki Cholidou2

  • 1First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vas. Sofias Ave., 11527 Athens, Greece.

Journal of Personalized Medicine
|January 27, 2026
PubMed

Insights

Hypoglycaemia in type 1 diabetes mellitus (T1DM) can cause cardiac arrhythmias due to autonomic dysfunction. Combined continuous glucose monitoring and ECG tracking may help detect risks early.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Hypoglycaemia in type 1 diabetes mellitus (T1DM) is a significant clinical issue.
  • It is associated with serious cardiac arrhythmias, yet mechanisms remain unclear.
  • Previous studies have limitations in population, cohort size, and monitoring duration.

Purpose of the Study:

  • To review experimental and clinical evidence linking glucose fluctuations to cardiac arrhythmias in T1DM.
  • To elucidate the roles of autonomic dysfunction and ionic imbalances in hypoglycaemia-induced electrophysiological instability and myocardial remodeling.
  • To highlight the potential of combined monitoring technologies for risk identification.

Main Methods:

  • Comprehensive review of existing experimental and clinical studies.
  • Analysis of evidence on autonomic dysfunction and ionic imbalances during hypoglycaemia.
  • Discussion of continuous glucose monitoring (CGM) and electrocardiography (ECG) applications.

Main Results:

  • Hypoglycaemia triggers autonomic dysfunction and ionic imbalances.
  • These factors contribute to myocardial electrophysiological instability and structural changes.
  • Combined CGM and ECG monitoring show promise for early detection.

Conclusions:

  • Autonomic and ionic disturbances during hypoglycaemia are key mechanisms for cardiac arrhythmias in T1DM.
  • Continuous glucose and cardiac rhythm monitoring can identify at-risk individuals.
  • Further prospective studies with combined CGM-ECG monitoring, especially during sleep, are crucial.

Keywords:
QTc prolongationatrial fibrillationautonomic dysfunctioncardiac arrhythmiacontinuous glucose monitoringdead-in-bed syndromehypoglycaemiaimpaired awareness of hypoglycaemiatype 1 diabetes mellitus

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