Diabetes Metab J.  2015 Dec;39(6):498-506. 10.4093/dmj.2015.39.6.498.

Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes

• Yun JS
• Ko SH
• Ko SH
• Song KH
• Yoo KD
• Yoon KH
• Park YM
• Ahn YB

• KMID: 2174002
• DOI: http://doi.org/10.4093/dmj.2015.39.6.498

Abstract

BACKGROUND
To investigate whether a history of prior cardiovascular disease (CVD) is associated with severe hypoglycemia (SH) in patients with type 2 diabetes.
METHODS
We conducted a prospective cohort study from January 2001 to December 2012 with a median follow-up time of 9.5 years (5,814 person-years). Patients aged 25 to 75 years with type 2 diabetes and without chronic kidney disease were enrolled (n=894), and 624 patients completed follow-up. SH was defined as hypoglycemic episodes requiring hospitalization or medical care in an emergency department. We used the Cox proportional hazards regression analysis to test associations between SH episodes and potential explanatory variables.
RESULTS
Among the 624 participants who completed follow-up, 60 patients (9.6%) had previous CVD. Compared to patients without CVD, patients with previous CVD were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline. During follow-up, 62 patients (9.9%) experienced at least one SH episode (incidence of 1.33 per 100 patient-years). The development of SH was associated with a history of CVD (hazard ratio, 1.99; 95% confidence interval, 1.07 to 3.72; P=0.031) after adjusting for sex, age, diabetic duration, hypertension, hemoglobin A1c levels, diabetic complications, cardiovascular autonomic neuropathy, and insulin use.
CONCLUSION
A history of CVD was an independent risk factor for the development of SH in patients with type 2 diabetes mellitus. For patients with CVD, modulation of glycemic targets and diabetic education for the prevention of hypoglycemia should be implemented.

Keyword

Cardiovascular diseases; Diabetes mellitus, type 2; Severe hypoglycemia

MeSH Terms

Cardiovascular Diseases*
Cohort Studies
Diabetes Complications
Diabetes Mellitus, Type 2
Education
Emergency Service, Hospital
Follow-Up Studies
Hospitalization
Humans
Hypertension
Hypoglycemia*
Insulin
Prospective Studies
Renal Insufficiency, Chronic
Risk Factors
Insulin

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