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Hypoglycemia Increased Risks for CV Events, Death in Diabetic Patients on Insulin

Increased risk seen in both type 1 and type 2 diabetes patients treated with insulin.

Insulin-treated patients with diabetes who experience hypoglycemia are also more likely to experience cardiovascular events and die from any cause, according to the current research. The link between hypoglycemia and CV outcomes and death remains over a long period, researchers from the University of Leicester, Imperial College London found.
Kamlesh Khunti, PhD, MD, University of Leicester, stated that, “This is one of the first studies to report the risk of CV events and mortality in people with both type 1 and type 2 diabetes. The risks are very significant, and we need to identify these patients early with a view to implementing strategies to reduce their risk of hypoglycemia.”

Khunti and colleagues conducted a retrospective cohort study using data from the Clinical Practice Research Datalink database, containing longitudinal, primary care records of approximately 5% of the country’s population registered with a general practice.

The researchers included all insulin-treated patients aged ≥30 years who were diagnosed with type 1 diabetes (n=3,260; 56% men) or type 2 diabetes (n=10,422; 56% men); a history of cardiovascular disease (CVD) existed in 11% of patients with type 1 and 14% of those with type 2 diabetes.

Among patients with type 1 diabetes who experienced hypoglycemia, the HRs for CV events were 1.51 (95% CI; 0.83–2.75) with a history of CVD before the index date and 1.61 (95% CI; 1.17–2.22) without; patients with type 2 had HRs of 1.6 (95% CI; 1.21–2.12) and 1.49 (95% CI; 1.23–1.82), respectively.

The HRs for all-cause mortality among patients with type 1 diabetes were 1.98 (95% CI; 1.25–3.17) with a history of CVD and 2.03 (95% CI; 1.66–2.47) without; for patients with type 2 diabetes, the HRs were 1.74 (95% CI; 1.39–2.18) and 2.48 (95% CI; 2.21–2.79), respectively.

The median time, by interquartile range, from first hypoglycemic event to first CV event was 1.5 years (95% CI; 0.5–3.5 years) for patients with type 1 and 1.5 years (95% CI; 0.5–3 years) for patients with type 2.

“Based on the results of our analysis and previously published studies, we recommend that special attention should be paid to insulin-treated patients who experience a hypoglycemic event — especially those who are at elevated risk for CV events — and an effort should be made to reduce the incidence of future hypoglycemic event,” the researchers wrote.

Practice Pearls:

  • Insulin-treated diabetes patients who suffered hypoglycemia were at an increased risk of cardiovascular events and all-cause mortality.
  • Special attention should be paid to insulin-treated patients who experience a hypoglycemic event especially those who are at elevated risk for CV events.

Khunti K. Diabetes Care. 2014;doi: 10.2337/dc14-0920.