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Type: Journal article
Title: Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes a nationwide population-based study
Author: Hsu, Pai-Feng
Sung, Shih-Hsien
Cheng, Hao-Min
Yeh, Jong-Shiuan
Liu, Wen-Ling
Chan, Wan-Leong
Chen, Chen-Huan
Chou, Pesus
Chuang, Shao-Yuan
Citation: Diabetes Care, 2013; 36(4):894-900
Publisher: American Diabetes Association
Issue Date: 2013
ISSN: 0149-5992
School/Discipline: School of Translational Health Sciences
Department: Faculty of Health Sciences
Statement of
Pai-Feng Hsu, Shih-Hsien Sung, Hao-Min Cheng, Jong-Shiuan Yeh, Wen-Ling Liu, Wan-Leong Chan, Chen-Huan Chen, Pesus Chou, Shao-Yuan Chuang
Abstract: OBJECTIVE Hypoglycemia is associated with serious health outcomes for patients treated for diabetes. However, the outcome of outpatients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown. RESEARCH DESIGN AND METHODS The study population, derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1998–2009, comprised 77,611 patients with newly diagnosed type 2 diabetes. We designed a prospective study consisting of randomly selected hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without hypoglycemia. We investigated the relationships of hypoglycemia with total mortality and cardiovascular events, including stroke, coronary heart disease, cardiovascular diseases, and all-cause hospitalization. RESULTS There were 1,844 hypoglycemic events (500 inpatients and 1,344 outpatients) among the 77,611 patients. Both mild (outpatient) and severe (inpatient) hypoglycemia cases had a higher percentage of comorbidities, including hypertension, renal diseases, cancer, stroke, and heart disease. In multivariate Cox regression models, including diabetes treatment adjustment, diabetic patients with hypoglycemia had a significantly higher risk of cardiovascular events during clinical treatment periods. After constructing a model adjusted with propensity scores, mild and severe hypoglycemia still demonstrated higher hazard ratios (HRs) for cardiovascular diseases (HR 2.09 [95% CI 1.63–2.67]), all-cause hospitalization (2.51 [2.00–3.16]), and total mortality (2.48 [1.41–4.38]). CONCLUSIONS Symptomatic hypoglycemia, whether clinically mild or severe, is associated with an increased risk of cardiovascular events, all-cause hospitalization, and all-cause mortality. More attention may be needed for diabetic patients with hypoglycemic episodes.
Rights: © 2013 by the American Diabetes Association.
DOI: 10.2337/dc12-0916
Appears in Collections:Medicine publications

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