TY - JOUR
T1 - Autonomic dysfunction and risk of severe hypoglycemia among individuals with type 2 diabetes
AU - Kaze, Arnaud D.
AU - Yuyun, Matthew F.
AU - Ahima, Rexford S.
AU - Rickels, Michael R.
AU - Echouffo-Tcheugui, Justin B.
N1 - Funding Information:
The authors wish to thank the staff of and participants in the ACCORD study for their valuable contributions. The ACCORD study has been supported by federal funds from the National Heart Lung and Blood Institute (NHLBI). The data from the ACCORD study were supplied to the investigators by the NHLBI through the Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC). JBET is funded by NIH/NHLBI grant K23 HL153774.
Publisher Copyright:
© 2022, Kaze et al. This is an open access article published under the terms of the Creative Commons Attribution 4.0 International License.
PY - 2022/11/22
Y1 - 2022/11/22
N2 - There are limited data on the link between cardiac autonomic neuropathy (CAN) and severe hypoglycemia in type 2 diabetes. Here, we evaluated the associations of CAN with severe hypoglycemia among 7,421 adults with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes study. CAN was defined using ECG-derived measures. Cox's and Andersen-Gill regression models were used to generate HRs (HRs) for the first and recurrent severe hypoglycemic episodes, respectively. Over 4.7 years, there were 558 first and 811 recurrent hypoglycemic events. Participants with CAN had increased risks of a first episode or recurrent episodes of severe hypoglycemia. The intensity of glycemic management modified the CAN association with hypoglycemia. In the standard glycemic management group, compared with those of participants without CAN, HRs for a first severe hypoglycemia event and recurrent hypoglycemia were 1.58 and 1.96, respectively. In the intensive glycemic management group, HRs for a first severe hypoglycemia event and recurrent hypoglycemia were 1.10 and 1.24, respectively. In summary, CAN was independently associated with higher risks of a first hypoglycemia event and recurrent hypoglycemia among adults with type 2 diabetes, with the highest risk observed among those on standard glycemic management.
AB - There are limited data on the link between cardiac autonomic neuropathy (CAN) and severe hypoglycemia in type 2 diabetes. Here, we evaluated the associations of CAN with severe hypoglycemia among 7,421 adults with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes study. CAN was defined using ECG-derived measures. Cox's and Andersen-Gill regression models were used to generate HRs (HRs) for the first and recurrent severe hypoglycemic episodes, respectively. Over 4.7 years, there were 558 first and 811 recurrent hypoglycemic events. Participants with CAN had increased risks of a first episode or recurrent episodes of severe hypoglycemia. The intensity of glycemic management modified the CAN association with hypoglycemia. In the standard glycemic management group, compared with those of participants without CAN, HRs for a first severe hypoglycemia event and recurrent hypoglycemia were 1.58 and 1.96, respectively. In the intensive glycemic management group, HRs for a first severe hypoglycemia event and recurrent hypoglycemia were 1.10 and 1.24, respectively. In summary, CAN was independently associated with higher risks of a first hypoglycemia event and recurrent hypoglycemia among adults with type 2 diabetes, with the highest risk observed among those on standard glycemic management.
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U2 - 10.1172/jci.insight.156334
DO - 10.1172/jci.insight.156334
M3 - Article
C2 - 36318703
AN - SCOPUS:85143487057
SN - 2379-3708
VL - 7
JO - JCI insight
JF - JCI insight
IS - 22
M1 - e156334
ER -