Association of Frequency of Hypoglycemic Episodes with Incident Cardiovascular Events in Adults with Type 2 Diabetes Mellitus: A National Database Study

Aman Rajpal, MD

ADA 2020 - Oral session

3 minute listen
6 minute read

Key messages

  • Adults with type 2 diabetes who have frequent hypoglycemic episodes (>5/year) tend to develop more cardiovascular events.
  • This suggests that glycemic targets should be individualized considering the risk for hypoglycemia.

Key messages

  • Adults with type 2 diabetes who have frequent hypoglycemic episodes (>5/year) tend to develop more cardiovascular events.
  • This suggests that glycemic targets should be individualized considering the risk for hypoglycemia.

Background

What do we already know about this topic?

  • Hypoglycemia has been linked to increased cardiovascular (CV) events.
  • However, there is limited data about the relationship between the frequency of hypoglycemic episodes and CV outcomes.

How was this study conducted?

  • This study evaluated the association of frequent hypoglycemic episodes (>5/year) with incident CV events in adults with type 2 diabetes (T2D).
  • A national database (IBM Explorys Solutions, IBM, Inc.) for adults with T2D who had >5 hypoglycemic episodes (cases) vs. 1 to 5 hypoglycemic episodes (controls) in one year was queried.
  • Primary outcomes were overall CV adverse events, acute myocardial infarction (MI), cerebrovascular accidents (CVA) and cardiac arrhythmias.

Findings

What does this study add?

  • Out of a total of 61,917,780 patients in Explorys, 4,882,710 had T2D, and 182,220 patients in the database had hypoglycemic episodes.
  • Patients were divided into 2 groups according to the number of hypoglycemic episodes per year (controls, 1-5, 158,410; cases, >5, 40,810).
  • Patients with >5 hypoglycemic episodes in 1 year (cases) had a higher incident risk of overall CV adverse events when compared to controls (OR: 1.61, 95% CI: 1.558, 1.663). 
  • Cases had more CV events (OR 1.61), cardiac arrythmias (OR 1.65), CVA (OR 1.38), and MI compared to controls (OR 1.43).
  • Cases who were elderly (age ≥65 years) had an incidence of 36% of having a CV event compared to 25% in age-matched controls.

Perspectives

How does this study impact clinical practice?

  • Adults with T2D with frequent hypoglycemic episodes (>5/year) tend to have higher incidence of adverse CV events.
  • Glycemic targets should be personalized for each patient on the basis of the individual risk of hypoglycemia.

Perspectives

How does this study impact clinical practice?

  • Adults with T2D with frequent hypoglycemic episodes (>5/year) tend to have higher incidence of adverse CV events.
  • Glycemic targets should be personalized for each patient on the basis of the individual risk of hypoglycemia.

This is a highlights summary of an oral session given at the ADA 2020 - 80th Scientific Sessions and presented by:

Aman Rajpal, MD
Dept. of Medicine, Case Western Reserve University and Cleveland VA Medical Center, Cleveland, Ohio, USA

The content is produced by Infomedica, the official reporting partner of ADA 2020 Virtual Meeting. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Dana M. Dabelea, MD, PhD, the scientific editor of the program.

The presenting authors of the original session had no part in the creation of this conference highlights

In addition, an expert commentary on the topic has been provided by:

Dott. Luca Monge
Centro piede diabetico, SC Endocrinologia, diabetologia e metabolismo,
AOU Città della Salute e della Scienza, Torino, Italy

Luca Monge, MD
Centro piede diabetico, SC Endocrinologia, diabetologia e metabolismo,
AOU Città della Salute e della Scienza, Torino, Italy

 

Luca Monge, MD is a diabetologist, expert in diabetes foot, and Head of the Diabetes Foot Center of AOU Città della Salute e della Scienza of Turin, Italy. Dr. Monge received his medical degree and his specialization in diabetology from the Università degli Studi of Turin, he completed his internship and training in diabetology at the San Giovanni Battista Hospital of Turin.
He is coordinator of the regional network of Diabetic Foot of the Piedmont region.
He is a member of the Associazione Medici Diabetologi (AMD) and was a member of the national council and regional president in Piedmont. He currently is Editor-in-Chief of The Journal of AMD (JAMD) and scientific and CME director of the distance learning program Diabetes Care online (Italian edition). He has over 100 publications.



Diabetes
Acute and Chronic Complications


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