Association of Clinical Symptomatic Hypoglycemia With Cardiovascular Events and Total Mortality in Type 2 Diabetes A nationwide population-based study

被引：202

作者：

Hsu, Pai-Feng ^{[1
,2
,3
,4
,5
]}

Sung, Shih-Hsien ^{[2
,3
,4
,5
]}

Cheng, Hao-Min ^{[2
,6
,7
]}

Yeh, Jong-Shiuan ^{[8
,9
,10
]}

Liu, Wen-Ling ^{[11
]}

Chan, Wan-Leong ^{[1
,5
]}

Chen, Chen-Huan ^{[2
,3
,4
]}

Chou, Pesus ^{[3
,4
]}

Chuang, Shao-Yuan ^{[11
]}

机构：

[1] Taipei Vet Gen Hosp, Healthcare & Management Ctr, Taipei, Taiwan

[2] Natl Yang Ming Univ, Dept Med, Taipei 112, Taiwan

[3] Natl Yang Ming Univ, Inst Publ Hlth, Taipei 112, Taiwan

[4] Natl Yang Ming Univ, Community Med Res Ctr, Taipei 112, Taiwan

[5] Taipei Vet Gen Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

[6] Univ Adelaide, Fac Hlth Sci, Joanna Briggs Inst, Adelaide, SA, Australia

[7] Taipei Vet Gen Hosp, Dept Med Res & Educ, Taipei, Taiwan

[8] Taipei Med Univ, Wan Fang Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

[9] Taipei Med Univ, Dept Med, Taipei, Taiwan

[10] Cardiovasc Res Fdn, Skirball Ctr Cardiovasc Res, Orangeburg, NY USA

[11] Natl Hlth Res Inst, Inst Populat Hlth Sci, Miaoli, Taiwan

来源：

DIABETES CARE | 2013年 / 36卷 / 04期

关键词：

NOCTURNAL HYPOGLYCEMIA; EPIDEMIOLOGIC ANALYSIS; GLUCOSE CONTROL; INSULIN; OUTCOMES; FREQUENCY; MELLITUS; TAIWAN; RISK; LIFE;

D O I：

10.2337/dc12-0916

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. Diabetes Care 36:894-900, 2013

引用

页码：894 / 900

页数：7

共 28 条

[1] Long-term persistence in use of statin therapy in elderly patients [J].