TY - JOUR
T1 - Risk factors for severe hypoglycemia in black and white adults with diabetes
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Lee, Alexandra K.
AU - Lee, Clare J.
AU - Huang, Elbert S.
AU - Sharrett, A. Richey
AU - Coresh, Josef
AU - Selvin, Elizabeth
N1 - Funding Information:
and participants of the ARIC Study for their important contributions. Funding. The ARIC Study is carried out as a col-laborativestudysupportedbyNationalHeart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). This research was supported by National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grants K24-DK-106414 and R01-DK-089174 to E.S. A.K.L. was supported by NIH/NHLBI grant T32HL007024. C.J.L. was supported by NIH/NIDDK grant 1K23-DK-107921. E.S.H. was supported by NIH/NIDDK grants K24-DK-105340 and P30-DK-092949 and by the Agency for Healthcare Research and Quality (AHRQ) grant R01-HS-018542. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. A.K.L. conceived and designed the study, conducted the statistical analyses, and wrote the manuscript. C.J.L., E.S.H., A.R.S., and J.C. made critical revisions to the manuscript for important intellectual content. E.S. helped to conceive and design the study,
Publisher Copyright:
© 2017 by the American Diabetes Association.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Objective: Severe hypoglycemia is a rare but important complication of type 2 diabetes. Few studies have examined the epidemiology of hypoglycemia in a community-based population. Research Design and Methods: We included 1,206 Atherosclerosis Risk in Communities (ARIC) Study participants with diagnosed diabetes (baseline: 1996-1998). Severe hypoglycemic events were identified through 2013 by ICD-9 codes from claims for hospitalizations, emergency department visits, and ambulance use. We used Cox regression to evaluate risk factors for severe hypoglycemia. Results: The mean age of participants was 64 years, 32% were black, and 54% were female. During amedian follow-up period of 15.2 years, therewere 185 severe hypoglycemic events. Important risk factors after multivariable adjustment were as follows: age (per 5 years: hazard ratio [HR] 1.24; 95% CI 1.07-1.43), black race (HR 1.39; 95% CI 1.02-1.88), diabetes medications (any insulin use vs. nomedications: HR 3.00; 95%CI 1.71-5.28; oral medications only vs. no medications: HR 2.20; 95% CI 1.28-3.76), glycemic control (moderate vs. good: HR 1.78; 95% CI 1.11-2.83; poor vs. good: HR 2.62; 95% CI 1.67-4.10), macroalbuminuria (HR 1.95; 95% CI 1.23-3.07), and poor cognitive function (Digit Symbol Substitution Test z score: HR 1.57; 95% CI 1.33-1.84). In an analysis of nontraditional risk factors, low 1,5-anhydroglucitol, difficulty with activities of daily living, Medicaid insurance, and antidepressant use were positively associated with severe hypoglycemia after multivariate adjustment. Conclusions: Poor glycemic control, glycemic variability as captured by 1,5-anhydroglucitol, kidney damage, and measures of cognitive and functional impairments were strongly associated with increased risk of severe hypoglycemia. These factors should be considered in hypoglycemia risk assessments when individualizing diabetes care for older adults.
AB - Objective: Severe hypoglycemia is a rare but important complication of type 2 diabetes. Few studies have examined the epidemiology of hypoglycemia in a community-based population. Research Design and Methods: We included 1,206 Atherosclerosis Risk in Communities (ARIC) Study participants with diagnosed diabetes (baseline: 1996-1998). Severe hypoglycemic events were identified through 2013 by ICD-9 codes from claims for hospitalizations, emergency department visits, and ambulance use. We used Cox regression to evaluate risk factors for severe hypoglycemia. Results: The mean age of participants was 64 years, 32% were black, and 54% were female. During amedian follow-up period of 15.2 years, therewere 185 severe hypoglycemic events. Important risk factors after multivariable adjustment were as follows: age (per 5 years: hazard ratio [HR] 1.24; 95% CI 1.07-1.43), black race (HR 1.39; 95% CI 1.02-1.88), diabetes medications (any insulin use vs. nomedications: HR 3.00; 95%CI 1.71-5.28; oral medications only vs. no medications: HR 2.20; 95% CI 1.28-3.76), glycemic control (moderate vs. good: HR 1.78; 95% CI 1.11-2.83; poor vs. good: HR 2.62; 95% CI 1.67-4.10), macroalbuminuria (HR 1.95; 95% CI 1.23-3.07), and poor cognitive function (Digit Symbol Substitution Test z score: HR 1.57; 95% CI 1.33-1.84). In an analysis of nontraditional risk factors, low 1,5-anhydroglucitol, difficulty with activities of daily living, Medicaid insurance, and antidepressant use were positively associated with severe hypoglycemia after multivariate adjustment. Conclusions: Poor glycemic control, glycemic variability as captured by 1,5-anhydroglucitol, kidney damage, and measures of cognitive and functional impairments were strongly associated with increased risk of severe hypoglycemia. These factors should be considered in hypoglycemia risk assessments when individualizing diabetes care for older adults.
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U2 - 10.2337/dc17-0819
DO - 10.2337/dc17-0819
M3 - Article
C2 - 28928117
AN - SCOPUS:85036659240
SN - 0149-5992
VL - 40
SP - 1661
EP - 1667
JO - Diabetes care
JF - Diabetes care
IS - 12
ER -