Hypoglycaemia is more frequent in type 2 diabetic patients with co-morbid vascular disease: an analysis of the DiaRegis registry

Gitt, Anselm K.; Bramlage, Peter; Binz, Christiane; Krekler, Michael; Plate, Tanja; Deeg, Evelin; Tschöpe, D

doi:10.1177/1741826711411104

Cited by 26 publications

(19 citation statements)

References 21 publications

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“…Furthermore, advanced DKD patients have been found to be at greater risk of hypoglycemia in cases involving decreased degradation of insulin in peripheral tissue [25], anorexics with suboptimal nutrition [26], reduced renal gluconeogenesis, and prolonged half-life of antidiabetic drugs. Rates of hypoglycemia have been found to be higher among those with older age, CHF, CAD, CVA, renal failure, autonomic neuropathy, and adrenocortical insufficiency [27–29]. In the current study, older patients and female patients with more comorbidities had higher rates of hypoglycemia.…”

Section: Discussionsupporting

confidence: 45%

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

et al. 2017

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BackgroundPatients with advanced diabetic kidney disease (DKD) behave differently to diabetic patients without kidney disease. We aimed to investigate the associations of hypoglycemia and outcomes after initiation of dialysis in patients with advanced DKD on dialysis.MethodsUsing National Health Insurance Research Database, 20,845 advanced DKD patients beginning long-term dialysis between 2002 and 2006 were enrolled. We investigated the incidence of severe hypoglycemia episodes before initiation of dialysis. Patients were followed from date of first dialysis to death, end of dialysis, or 2008. Main outcomes measured were all-cause mortality, myocardial infarction (MI), and subsequent severe hypoglycemic episodes after dialysis.Results19.18% patients had at least one hypoglycemia episode during 1-year period before initiation of dialysis. Advanced DKD patients with higher adapted Diabetes Complications Severity Index (aDCSI) scores were associated with more frequent hypoglycemia (P for trend < 0.001). Mortality and subsequent severe hypoglycemia after dialysis both increased with number of hypoglycemic episodes. Compared to those who had no hypoglycemic episodes, those who had one had a 15% higher risk of death and a 2.3-fold higher risk of subsequent severe hypoglycemia. Those with two or more episodes had a 19% higher risk of death and a 3.9-fold higher risk of subsequent severe hypoglycemia. However, previous severe hypoglycemia was not correlated with risk of MI after dialysis.ConclusionsThe rate of severe hypoglycemia was high in advanced DKD patients. Patients with higher aDCSI scores tended to have more hypoglycemic episodes. Hypoglycemic episodes were associated with subsequent hypoglycemia and mortality after initiation of dialysis. We studied the associations and further study is needed to establish cause. In addition, more attention is needed for hypoglycemia prevention in advanced DKD patients, especially for those at risk patients.

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Section: Discussionsupporting

confidence: 45%

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

et al. 2017

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“…The study protocol and baseline characteristics of the patient population have been published [9,10]. This registry is conducted in accordance with Good Epidemiology Practices (GEP), and applicable regulatory requirements.…”

Section: Methodsmentioning

confidence: 99%

Antidiabetic pharmacotherapy and anamnestic hypoglycemia in a large cohort of type 2 diabetic patients - an analysis of the DiaRegis registry

Tschöpe

Bramlage²,

Binz

et al. 2011

Cardiovasc Diabetol

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“…Table 2 gives an overview of those studies closely related to the objectives of DIALOGUE. These include DUTY [34], DIG [35-37] and DiaRegis [2,38-40]. DUTY (2001–2003) was among the first [34] to prospectively document the effect of a tailored intervention on blood glucose and CV risk factor target achievement.…”

Section: Discussionmentioning

confidence: 99%

Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice -- study rationale and protocol of DIALOGUE

Gitt

Schmieder

Duetting

et al. 2012

Cardiovasc Diabetol

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BackgroundPatients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD.MethodsDIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1) individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2) individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE) and the rate of hospitalizations are the most important.ConclusionThe registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti-diabetic and anti-hypertensive drugs in clinical trials and their real world balance of effectiveness and safety.

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Hypoglycaemia is more frequent in type 2 diabetic patients with co-morbid vascular disease: an analysis of the DiaRegis registry

Abstract: As hypothesized there is a strong association between the incidence of hypoglycaemia and vascular disease at comparable glycaemic control, which confirms prior randomized controlled trial data suggesting an interrelationship between hypoglycaemia and vascular disease.

Cited by 26 publications

References 21 publications

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

Epidemiology and outcomes of hypoglycemia in patients with advanced diabetic kidney disease on dialysis: A national cohort study

Antidiabetic pharmacotherapy and anamnestic hypoglycemia in a large cohort of type 2 diabetic patients - an analysis of the DiaRegis registry

Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice -- study rationale and protocol of DIALOGUE

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