Exposure to hypoglycemia and risk of stroke

Smith, Logan; Chakraborty, Diya; Bhattacharya, Pallab; Sarmah, Deepaneeta; Koch, Sebastian; Dave, Kunjan R.

doi:10.1111/nyas.13872

Cited by 37 publications

(35 citation statements)

References 108 publications

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“…They explained the negative results of stroke and heart failure by the possibility of a small number of SH events or competing risks for mortality. Hypoglycemia also has a significant effect on the cerebral vascular system affecting systemic cardiovascular system by promoting inflammation, hypocoagulability, endothelial dysfunction, and oxidative stress [40]. Changing blood flow during hypoglycemia enhances the supply of glucose to the most vulnerable part of the brain which becomes permanent and persist during normoglycemia [41].…”

Section: Discussionmentioning

confidence: 99%

Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study

Yun

Park

Han

et al. 2019

Cardiovasc Diabetol

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Background We investigated the association regarding severe hypoglycemia episodes with cardiovascular disease risk and all-cause mortality in patients with type 2 diabetes. Methods Baseline and follow-up data (n = 1,568,097) from patients with type 2 diabetes were retrieved from the National Health Insurance System database (covering the entire Korean population). Type 2 diabetes, severe hypoglycemia, and major comorbidities were identified using International Classification of Diseases 10 codes and medication information. Individuals who were classified as type 2 diabetes in the year of 2009 were screened, and we counted severe hypoglycemia episodes from 2007 to 2009. The primary outcome was newly developed myocardial infarction (MI), stroke, heart failure, or all-cause mortality. Participants were followed from the baseline index date to the date of death or until December 31, 2015. Results In total, 19,660 (1.2%) patients developed at least one severe hypoglycemia event during the period from 2007 to 2009. Mean follow-up was 5.7 years. After adjustment for confounding factors, the hazard ratio (HR) of MI significantly and sequentially increased: 0 vs. 1 episode, HR 1.56, 95% CI 1.46–1.64; 0 vs. 2 episodes, HR 1.86, 95% CI 1.61–2.15; 0 vs. 3 or more episodes, HR 1.86, 95% CI 1.48–2.35, P for trend < 0.001. Similar findings were noted regarding the relationship of severe hypoglycemia episodes with stroke, heart failure, and all-cause mortality. Risks for all outcomes were highest within 1 year from the index date and showed decreasing trends with follow-up. Sensitivity analyses of the data from the subgroup population and 797,544 subjects who received a national health examination did not change the significance of the main findings. Conclusion Among adult Korean patients with type 2 diabetes, a severe hypoglycemia episode is associated with increased risk for cardiovascular outcomes and all-cause mortality. Significant results from dose–response, temporal, and sensitivity analyses may suggest the possibility of direct causality between severe hypoglycemia and cardiovascular outcomes and mortality. Electronic supplementary material The online version of this article (10.1186/s12933-019-0909-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study

Yun

Park

Han

et al. 2019

Cardiovasc Diabetol

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“…Nor did we have any data on thrombectomy, or frequencies of carotid stenosis, which may have influenced our results. We also did not have any information on hypoglycaemia, 30 the type of per-oral anti-diabetic medications, 31 or the use of other injectable medications (except for insulin), which may also have affected the outcomes of interest. 31,32 In conclusion, people with T2D had an increased risk of stroke compared with a matched general population.…”

Section: Discussionmentioning

confidence: 99%

Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Zabala

Darsalia

Holzmann

et al. 2019

Diabetes Obesity Metabolism

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Aims To compare stroke incidence in people with type 2 diabetes (T2D) with that in a matched control group, and to investigate whether glucose exposure in people with T2D can predict a first‐time stroke event and mortality. Material and methods In a nationwide observational cohort study, individuals with T2D were linked in the Swedish National Diabetes Register and matched with five individual population‐based control subjects. We calculated crude incidence rates and 95% confidence intervals (CIs), and used Cox regression and multivariable hazard ratios (HRs), to estimate the risk of stroke and mortality in relation to glycated haemoglobin (HbA1c) levels. Results A total of 406 271 people with T2D (age 64.1 ± 12.4 years, 45.7% women) and 2086 440 control subjects (age 64.0 ± 12.4 years, 45.7% women) were included. During a median follow‐up of 7.3 years, 26 380 people with T2D (6.5%) versus 92 375 control subjects (4.4%) were diagnosed with a stroke. The incidence rate was 10.12 events per 1000 person‐years versus 7.26 events per 1000 person‐years (HR 1.54, 95% CI 1.52‐1.56). In the T2D group after multivariable adjustments, the HRs for stroke stratified by HbA1c level were: 54‐64 mmol/mol: 1.27 (95% CI 1.22‐1.32); 65‐75 mmol/mol: 1.68 (95% CI 1.60‐1.76); 76‐86 mmol/mol: 1.89 (95% CI, 1.75‐2.05); and > 87 mmol/mol: 2.14 (95% CI 1.90‐2.42), respectively, compared with the reference category of HbA1c ≤53 mmol/mol. There was a stepwise increased risk of death after stroke, for every 10‐mmol/mol categorical increment of HbA1c (HR 1.71; 95% CI 1.47‐2.00) for the highest HbA1c category. Conclusions An increased risk of stroke and death was associated with poor glycaemic control in people with T2D.

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“…One animal study illustrated that the occurrence of hypoglycemia in a cat model caused larger brain infarcts and an increased mortality rate 31 . Preclinical research implied that hypoglycemia possibly increased the risk of stroke in diabetic patients 32 . Overuse of medication to decrease blood sugar can result in hypoglycemia in patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke

Chen

Lee

Huang

et al. 2019

Sci Rep

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Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/ m 2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson-Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.

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Exposure to hypoglycemia and risk of stroke

Cited by 37 publications

References 108 publications

Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study

Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study

Risk of first stroke in people with type 2 diabetes and its relation to glycaemic control: A nationwide observational study

Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke

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