Hypoglycemia and risk of vascular events and mortality

a systematic review and meta-analysis

Jong Shiuan Yeh, Shih Hsien Sung, Hui Mei Huang, Huei Ling Yang, Li Kai You, Shao Yuan Chuang, Po Chieh Huang, Pai Feng Hsu, Hao Min Cheng, Chen Huan Chen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims: Hypoglycemia has been associated with adverse outcomes in patients with diabetes and critical illness. However, such associations in these populations have not been systematically examined. Methods: We conducted a systematic review and meta-analysis of longitudinal follow-up cohort studies to investigate the associations between hypoglycemia and various adverse outcomes.Results: After removing duplicates and critically appraising all screened citations, a total of 19 eligible studies were included. As demonstrated by random-effects meta-analysis, hypoglycemia was strongly associated with a higher risk of adverse events (HR 1.90, 95 % CI 1.63–2.20; P <0.001). Comparable risk ratios were shown in prespecified stratified analyses investigating above association for different study endpoints, in patients with or without critical illness, in patients with and without diabetes (from 1.47 to 3.31; p for interaction or heterogeneity >0.1). Additionally, a dose-dependent relationship between the severity of hypoglycemia and adverse vascular events and mortality (HR for mild hypoglycemia: 1.68, 95 % CI 1.25–2.26; P <0.001 and HR for severe hypoglycemia: 2.33, 95 % CI 2.07–2.61; P <0.001; p for trend 0.02) was observed. Suggested by a bias analysis, the above observations were unlikely to have resulted from unmeasured confounding parameters. Conclusions: This is the first study demonstrating that hypoglycemia was associated with comparable risk ratios in different study populations and various study endpoints, and a trend of a dose-dependent relationship between hypoglycemia severity and adverse events. The findings of this systematic review support the speculation that hypoglycemia is a risk factor for adverse vascular events and mortality.

Original languageEnglish
JournalActa Diabetologica
DOIs
Publication statusAccepted/In press - Aug 25 2015

Fingerprint

Hypoglycemia
Blood Vessels
Meta-Analysis
Mortality
Critical Illness
Population
Cohort Studies
Odds Ratio

Keywords

  • Hypoglycemia
  • Mortality
  • Risk factor
  • Vascular events

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Yeh, J. S., Sung, S. H., Huang, H. M., Yang, H. L., You, L. K., Chuang, S. Y., ... Chen, C. H. (Accepted/In press). Hypoglycemia and risk of vascular events and mortality: a systematic review and meta-analysis. Acta Diabetologica. https://doi.org/10.1007/s00592-015-0803-3

Hypoglycemia and risk of vascular events and mortality : a systematic review and meta-analysis. / Yeh, Jong Shiuan; Sung, Shih Hsien; Huang, Hui Mei; Yang, Huei Ling; You, Li Kai; Chuang, Shao Yuan; Huang, Po Chieh; Hsu, Pai Feng; Cheng, Hao Min; Chen, Chen Huan.

In: Acta Diabetologica, 25.08.2015.

Research output: Contribution to journalArticle

Yeh, JS, Sung, SH, Huang, HM, Yang, HL, You, LK, Chuang, SY, Huang, PC, Hsu, PF, Cheng, HM & Chen, CH 2015, 'Hypoglycemia and risk of vascular events and mortality: a systematic review and meta-analysis', Acta Diabetologica. https://doi.org/10.1007/s00592-015-0803-3
Yeh, Jong Shiuan ; Sung, Shih Hsien ; Huang, Hui Mei ; Yang, Huei Ling ; You, Li Kai ; Chuang, Shao Yuan ; Huang, Po Chieh ; Hsu, Pai Feng ; Cheng, Hao Min ; Chen, Chen Huan. / Hypoglycemia and risk of vascular events and mortality : a systematic review and meta-analysis. In: Acta Diabetologica. 2015.
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AU - Sung, Shih Hsien

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AU - Yang, Huei Ling

AU - You, Li Kai

AU - Chuang, Shao Yuan

AU - Huang, Po Chieh

AU - Hsu, Pai Feng

AU - Cheng, Hao Min

AU - Chen, Chen Huan

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N2 - Aims: Hypoglycemia has been associated with adverse outcomes in patients with diabetes and critical illness. However, such associations in these populations have not been systematically examined. Methods: We conducted a systematic review and meta-analysis of longitudinal follow-up cohort studies to investigate the associations between hypoglycemia and various adverse outcomes.Results: After removing duplicates and critically appraising all screened citations, a total of 19 eligible studies were included. As demonstrated by random-effects meta-analysis, hypoglycemia was strongly associated with a higher risk of adverse events (HR 1.90, 95 % CI 1.63–2.20; P <0.001). Comparable risk ratios were shown in prespecified stratified analyses investigating above association for different study endpoints, in patients with or without critical illness, in patients with and without diabetes (from 1.47 to 3.31; p for interaction or heterogeneity >0.1). Additionally, a dose-dependent relationship between the severity of hypoglycemia and adverse vascular events and mortality (HR for mild hypoglycemia: 1.68, 95 % CI 1.25–2.26; P <0.001 and HR for severe hypoglycemia: 2.33, 95 % CI 2.07–2.61; P <0.001; p for trend 0.02) was observed. Suggested by a bias analysis, the above observations were unlikely to have resulted from unmeasured confounding parameters. Conclusions: This is the first study demonstrating that hypoglycemia was associated with comparable risk ratios in different study populations and various study endpoints, and a trend of a dose-dependent relationship between hypoglycemia severity and adverse events. The findings of this systematic review support the speculation that hypoglycemia is a risk factor for adverse vascular events and mortality.

AB - Aims: Hypoglycemia has been associated with adverse outcomes in patients with diabetes and critical illness. However, such associations in these populations have not been systematically examined. Methods: We conducted a systematic review and meta-analysis of longitudinal follow-up cohort studies to investigate the associations between hypoglycemia and various adverse outcomes.Results: After removing duplicates and critically appraising all screened citations, a total of 19 eligible studies were included. As demonstrated by random-effects meta-analysis, hypoglycemia was strongly associated with a higher risk of adverse events (HR 1.90, 95 % CI 1.63–2.20; P <0.001). Comparable risk ratios were shown in prespecified stratified analyses investigating above association for different study endpoints, in patients with or without critical illness, in patients with and without diabetes (from 1.47 to 3.31; p for interaction or heterogeneity >0.1). Additionally, a dose-dependent relationship between the severity of hypoglycemia and adverse vascular events and mortality (HR for mild hypoglycemia: 1.68, 95 % CI 1.25–2.26; P <0.001 and HR for severe hypoglycemia: 2.33, 95 % CI 2.07–2.61; P <0.001; p for trend 0.02) was observed. Suggested by a bias analysis, the above observations were unlikely to have resulted from unmeasured confounding parameters. Conclusions: This is the first study demonstrating that hypoglycemia was associated with comparable risk ratios in different study populations and various study endpoints, and a trend of a dose-dependent relationship between hypoglycemia severity and adverse events. The findings of this systematic review support the speculation that hypoglycemia is a risk factor for adverse vascular events and mortality.

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KW - Mortality

KW - Risk factor

KW - Vascular events

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