Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes

A nationwide population-based study

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

Research output: Contribution to journalArticle

141 Citations (Scopus)

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-Therewere 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.

Original languageEnglish
Pages (from-to)894-900
Number of pages7
JournalDiabetes Care
Volume36
Issue number4
DOIs
Publication statusPublished - Apr 2013

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Hypoglycemia
Type 2 Diabetes Mellitus
Mortality
Population
Hypoglycemic Agents
Hospitalization
Outpatients
Inpatients
Cardiovascular Diseases
Stroke
Propensity Score
Kidney Neoplasms
Health
National Health Programs
Taiwan
Proportional Hazards Models
Coronary Disease
Comorbidity
Heart Diseases
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes : A nationwide population-based study. / 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.

In: Diabetes Care, Vol. 36, No. 4, 04.2013, p. 894-900.

Research output: Contribution to journalArticle

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. / Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes : A nationwide population-based study. In: Diabetes Care. 2013 ; Vol. 36, No. 4. pp. 894-900.
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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-Therewere 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.",
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T1 - Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes

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AU - Hsu, Pai Feng

AU - Sung, Shih Hsien

AU - Cheng, Hao Min

AU - Yeh, Jong Shiuan

AU - Liu, Wen Ling

AU - Chan, Wan Leong

AU - Chen, Chen Huan

AU - Chou, Pesus

AU - Chuang, Shao Yuan

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N2 - 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-Therewere 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.

AB - 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-Therewere 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.

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