In the Journals

Hypoglycemia linked to CVD, mortality in type 1 diabetes

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July 20, 2016

Patients with type 1 diabetes who experienced severe hypoglycemic events in the past year faced an increased risk for death or cardiovascular disease than patients who had not, according to data from a population-based cohort study.

“Although patients with [type 1 diabetes] may suffer more frequently from hypoglycemia than those with [type 2 diabetes], very few studies have investigated whether hypoglycemia may also increase the risk of CVD or death in patients with [type 1 diabetes],” Chin-Li Lu, PhD, of the College of Medicine, National Cheng Kung University, Taiwan, and colleagues wrote.

Researchers conducted two nested case-control studies using a cohort of patients with type 1 diabetes (n = 10,411) in Taiwan to determine the effects of hypoglycemia on risk for all-cause mortality and CVD. They included data for 564 nonsurvivors identified from the Taiwan Death Registry and matched them with 1,615 control patients identified from the country’s National Health Insurance Research Database. Patients who developed a major CV event (n = 743) and those who did not (control patients, n = 1,439) were also identified. Severe hypoglycemia was defined using the American Diabetes Association’s criteria — any hypoglycemic event that requires the patient to seek assistance from another person.

Patients who had severe hypoglycemic events in the past year were 2.74 times more likely to die (95% CI, 1.96-3.85), the researchers found, and 2.02 times more likely to develop CVD (95% CI, 1.35-3.01). Hypoglycemic events that occurred in the past 1 to 3 years or 3 to 5 years were also associated with higher all-cause mortality (OR = 1.94; 95% CI, 1.39-2.71 and OR = 1.68; 95% CI, 1.15-2.44, respectively).

Of those patients who died, researchers identified three major causes: 44.8% died of diabetes, 16.4% died of malignant neoplasm and 12.4% died of circulatory disease. The deceased also tended to live in more rural areas and have lower income-based insurance premiums, the researchers added.

“Patients and clinical practitioners should appropriately manage [type 1 diabetes] to prevent the occurrence of severe hypoglycemia and must be alerted by the possible risks of all-cause mortality/CVD incidence in the following year after the patient experiences severe hypoglycemic events,” Lu and colleagues wrote. – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.