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- Title
A Link Between Hypoglycemia and Progression of Atherosclerosis in the Veterans Affairs Diabetes Trial (VADT).
- Authors
Saremi, Aramesh; Bahn, Gideon D.; Reaven, Peter D.; Veterans Affairs Diabetes Trial (VADT)
- Abstract
<bold>Objective: </bold>To determine whether a link exists between serious hypoglycemia and progression of atherosclerosis in a substudy of the Veterans Affairs Diabetes Trial (VADT) and to examine whether glycemic control during the VADT modified the association between serious hypoglycemia and coronary artery calcium (CAC) progression. <bold>Research Design and Methods: </bold>Serious hypoglycemia was defined as severe episodes with loss of consciousness or requiring assistance or documented glucose <50 mg/dL. Progression of CAC was determined in 197 participants with baseline and follow-up computed tomography scans. <bold>Results: </bold>During an average follow-up of 4.5 years between scans, 97 participants reported severe hypoglycemia (n = 23) or glucose <50 mg/dL (n = 74). Serious hypoglycemia occurred more frequently in the intensive therapy group than in the standard treatment group (74% vs. 21%, P < 0.01). Serious hypoglycemia was not associated with progression of CAC in the entire cohort, but the interaction between serious hypoglycemia and treatment was significant (P < 0.01). Participants with serious hypoglycemia in the standard therapy group, but not in the intensive therapy group, had ∼50% greater progression of CAC than those without serious hypoglycemia (median 11.15 vs. 5.4 mm(3), P = 0.02). Adjustment for all baseline differences, including CAC, or time-varying risk factors during the trial, did not change the results. Examining the effect of serious hypoglycemia by on-trial HbA1c levels (cutoff 7.5%) yielded similar results. In addition, a dose-response relationship was found between serious hypoglycemia and CAC progression in the standard therapy group only. <bold>Conclusions: </bold>Despite a higher frequency of serious hypoglycemia in the intensive therapy group, serious hypoglycemia was associated with progression of CAC in only the standard therapy group.
- Subjects
DIABETES; HYPOGLYCEMIA; ATHEROSCLEROSIS; DISEASE progression; GLYCEMIC control; BLOOD sugar analysis; TYPE 2 diabetes complications; COMPARATIVE studies; CORONARY disease; DIABETIC angiopathies; HYPOGLYCEMIC agents; VETERANS; RESEARCH methodology; MEDICAL cooperation; TYPE 2 diabetes; RESEARCH; RESEARCH funding; EVALUATION research; CALCINOSIS
- Publication
Diabetes Care, 2016, Vol 39, Issue 3, p448
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc15-2107