Absolute risk of acute coronary syndrome after severe hypoglycemia: A population‐based 2‐year cohort study using the National Database in Japan

Abstract

Aims/Introduction Although the epidemiological relationship between hypoglycemia and increased risk of acute coronary syndrome (ACS) has been well established, the time period for increased risk of ACS after a severe hypoglycemic episode remains unknown. The present study aimed to determine the ACS risk after a severe hypoglycemic episode. Materials and Methods We carried out a retrospective population‐based cohort study based on national claims data in Japan. We retrieved data of diabetes patients aged ≥35 years collected from April 2014 to March 2016. The absolute risk of ACS was defined as the occurrence of an emergency percutaneous coronary intervention after a severe hypoglycemic episode. Results In total, data of 7,909,626 patients were included in the analysis. The absolute risk of ACS was 2.9 out of 1,000 person‐years in all patients. ACS risk in patients with severe hypoglycemic episodes was 3.0 out of 1,000 person‐years. Severe hypoglycemic episodes increased the absolute risk of ACS in patients aged ≥70 years, but not in patients aged <70 years. The absolute risk of ACS was 10.6 out of 1,000 person‐years within 10 days of a severe hypoglycemic episode. There was a significant trend between shorter duration after an episode and higher ACS risk. Conclusions Severe hypoglycemia was associated with an increased risk of ACS in elderly diabetes patients. ACS risk increased with a shorter period after a severe hypoglycemic episode, suggesting that severe hypoglycemia leads to an increased risk of ACS in diabetes patients. These findings show that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.

Prevalence of patients with rheumatoid arthritis and age‐stratified trends in clinical characteristics and treatment, based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan

“…In April 2009, the database became accessible for the purpose of research projects and health‐relevant policy‐making in Japan. The NDB Japan details have been described in previous studies 26‐28 . In brief, the NDB Japan covers >90% of patients.…”

“…The NDB Japan details have been described in previous studies. [26][27][28] In brief, the NDB Japan covers >90% of patients. Almost all the monthly claims that were submitted electronically have been comprehensively categorized.…”

Inpatient Hypoglycemia: The Challenge Remains

“…6 SH increased the risk of acute coronary syndrome, especially in adults aged 70 or greater and in the first 10 days after the SH event in a large cohort study. 7 Frequent exposure to hypoglycemia might increase the risk of stroke. 8 Hypoglycemia was also associated with in-hospital falls.…”

Accuracy of Japanese claims data in identifying diabetes‐related complications

“…Insurance claims databases have been increasingly used for studies to identify risk factors for cardiovascular disease and to compare the effectiveness of drugs in treating cardiovascular disease 6‐8 . Recently, studies using claims data have increased in the field of diabetes in Japan 9‐17 . In Japan claims data are recorded electronically using unique master codes 18 .…”