Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes.

Jae-Seung Yun; Seung-Hyun Ko; Sun-Hye Ko; Ki-Ho Song; Ki-Dong Yoo; Kun-Ho Yoon; Yong-Moon Park; Yu-Bae Ahn

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 epi-sodes 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.

CARDIOVASCULAR diseases; HYPOGLYCEMIA; TYPE 2 diabetes

Diabetes & Metabolism Journal, 2015, Vol 39, Issue 6, p498

2233-6079

Academic Journal

10.4093/dmj.2015.39.6.498