A Population-Based Study of All-Cause Mortality and Cardiovascular Disease in Association With Prior History of Hypoglycemia Among Patients With Type 1 Diabetes

Lu, Chin-Li; Shen, Hsiu-Nien; Hu, Susan C.; Wang, Jung‐Der; Li, Chung‐Yi

doi:10.2337/dc15-2418

Cited by 61 publications

(42 citation statements)

References 32 publications

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“…In a Taiwanese cohort study, the adjusted HR was 1.57 for diabetes with a history of SH as compared to those without [58]. Another study reported an elevated risk of fall associated with a history of hypoglycemia (adjusted HR, 1.36; 95% CI, 1.13 to 1.65) [59].…”

Section: Adverse Outcomes Of Severe Hypoglycemiamentioning

confidence: 99%

Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus

Yun

2016

Diabetes Metab J

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Hypoglycemia has been considered as a major barrier to achieving the proper glycemic target in type 2 diabetes mellitus patients. In particular, severe hypoglycemia (SH), which is defined as a hypoglycemic episode requiring the assistance of another person to raise the patient's glucose level, is a serious complication of diabetes because of its possible fatal outcomes. Recently, the recommendations for diabetes care have emphasized a patient-centered approach, considering the individualized patient factors including hypoglycemia. Many studies have been performed which analyzed the risk factors and clinical outcomes for SH. From the studies, researchers recommend that targeting a less stringent glycosylated hemoglobin level and selecting a safer class of drugs for hypoglycemia are appropriate for patients with a high risk of SH. Also, careful clinical attention to prevent hypoglycemia, including intensive education, is necessary to minimize the risk of SH and SH-related fatal outcomes.

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Section: Adverse Outcomes Of Severe Hypoglycemiamentioning

confidence: 99%

Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus

Yun

2016

Diabetes Metab J

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“…Severe hypoglycemia is recognized as one of the strongest predictors of macrovascular events in patients with type 1 diabetes and type 2 diabetes, which was also noted by studies from Taiwan and Japan. The increased risk of cardiovascular diseases is associated with long‐term hypoglycemia, either as a result of weight gain related to defensive food intake, or through activation of the sympathoadrenal response.…”

Section: Challenges With Basal Insulin Therapy In Asiamentioning

confidence: 85%

Basal insulin therapy: Unmet medical needs in Asia and the new insulin glargine in diabetes treatment

Tien

Hung

Chen

et al. 2019

J of Diabetes Invest

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Diabetes remains a global epidemic and a tremendous health challenge, especially in the Asian population. Dramatic increases in the prevalence of diabetes across different countries or areas in Asia have been reported in recent epidemiological studies. Although clinical guidelines have strengthened appropriate antihyperglycemic medications and lifestyle modifications for optimal diabetes management, inadequate glycemic control still occurs in many patients with an increased risk of developing microvascular and macrovascular complications. Insulin administration is the main therapy for diabetes in response to the inability to secrete insulin, and is recommended in current guidelines to treat patients with type 2 diabetes after failure of oral antidiabetic drugs. Clinical studies have shown that long‐acting insulin analogs improve basal glycemic control with reduced risk of hypoglycemia. In the present review, we discuss previous challenges with basal insulin therapy in Asia, the pharmacological development of insulin analogs to overcome the unmet medical needs and recent clinical studies of the new ultra‐long‐acting insulin analog, insulin glargine U300. Furthermore, relevant findings of current real‐world evidence are also included for the comparison of the efficacy and safety of different insulin formulations. Based on the accumulating evidence showing a low incidence of hypoglycemia and technical benefits of dose titration, treatment with glargine U300 can be a promising strategy for Asian diabetes patients to achieve glycemic targets with favorable safety.

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confidence: 99%

“…70 The authors conclud ed that repeated severe hypoglycemic events can lead to higher risk of mortality and cardiovascu lar disease. 70 Furthermore, a study among Swed ish patients with type 1 diabetes found that those with prior severe hypoglycemic events present ed an increased risk of mortality after a cardio vascular event. 71 Unfortunately, the mechanism of hypoglyce miarelated all cause mortality and cardiovas cular events is not fully known; it is only sus pected that it is due to sympathetic adrenal ac tivations, prolonged cardiac repolarization, and increased cardiac arrhythmia risk.…”

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Hypoglycemia in patients with insulin‑treated diabetes

Gumprecht¹,

Nabrdalik²

2016

Polish Archives of Internal Medicine

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studies indicate that the event rates for severe hy poglycemia range from 110 to 320 per 100 patient years for patients with type 1 diabetes and from 10 to 70 per 100 patient years for patients with type 2 diabetes. 6,7 Fatal episodes of hypoglycemia are presumably the outcome of ventricular cardiac arrhythmias, not brain death, perhaps mediated by sympathoadrenal activation and possible hy pokalemia, even though profound and prolonged hypoglycemia can be a cause of brain death. 8,9 Re gardless of the type of diabetes, the pathophysi ological mechanism of hypoglycemia, its associ ated risk factors, and interventions to reduce its occurrence must be understood by health care providers to minimize the risk of hypoglycemia. Therefore, in this article, we summarize the phys iology of hypoglycemia, as well as some major as pects of hypoglycemia related health consequenc es and possible ways to avoid them.Definition and physiology of hypoglycemia Healthy people without diabetes maintain a plasma glu cose concentration in the range of 70 to 99 mg/dl in the fasting state, and less than 140 mg/dl in the postprandial state.5 Traditionally, hypogly cemia is defined by the following 3 factors (also known as the Whipple's triad): 1) the development Introduction Patients with diabetes treated with insulin must maintain euglycemia, which often takes years of delicate balancing between avoid ing hyperglycemia and hypoglycemia. It is hypo glycemia that seems to be the main barrier for obtaining optimal glycemic control in both type 1 and type 2 diabetes. 1-3 Good glycemic manage ment of diabetes prevents or delays microvascu lar complications and may reduce the risk of mac rovascular events.2,3 For many years, a target he moglobin A 1c (HbA 1c ) of less than 7% has been rec ommended in most adult patients. Since 2013, the American Diabetes Association (ADA) rec ommendation for the treatment of diabetes pro posed patient centered glycemic goals, in which the general aim is to lower HbA 1c below 7% (as previously) but to compromise to HbA 1c below 8% when there is a high risk of hypoglycemia occur rence (ie, patients with a history of severe hypo glycemia, limited life expectancy, advanced micro and macrovascular complications) and strength en it to HbA 1c below 6.5% when it can be reached without significant hypoglycemia. 4,5The incidence of hypoglycemia differs between studies, and that is why it is difficult to compare data due to different study designs, populations, and definitions of hypoglycemia used. Available REVIEW ARTICLE Hypoglycemia in patients with insulin treated diabetesJanusz Gumprecht, Katarzyna Nabrdalik ABSTRACTHypoglycemia is the major barrier for optimal glycemic control in patients on maintenance insulin therapy. It is widely known that good glycemic control leads to prevention of or delay in the development of microvascular complications, and can reduce macrovascular events. It is thought that hypoglycemia may predispose patients to cognitive deterioration and may negatively affect the cardiovascular syst...

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A Population-Based Study of All-Cause Mortality and Cardiovascular Disease in Association With Prior History of Hypoglycemia Among Patients With Type 1 Diabetes

Cited by 61 publications

References 32 publications

Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus

Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus

Basal insulin therapy: Unmet medical needs in Asia and the new insulin glargine in diabetes treatment

Hypoglycemia in patients with insulin‑treated diabetes

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