Severe hypoglycemia and coronary artery calcification during the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study

Fahrmann, Elke R.; Adkins, Laura J.; Loader, Cameron J.; Han, Hugang; Rice, Kevin M.; Denvir, James; Driscoll, Henry K.

doi:10.1016/j.diabres.2014.10.007

Cited by 37 publications

(30 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are supported by two previous studies that investigated atherosclerosis risk in T1DM (13,14). The DCCT/EDIC project reported that the prevalence of coronary artery calcification, an established atherosclerosis marker, was linearly correlated with the incidence rate of hypoglycemia on the DCCT stage (14).…”

Section: Comparison With Previous Studiessupporting

confidence: 80%

“…Second, although previous studies found that the effects of hypoglycemia on mortality and progression of atherosclerosis in diabetes can be modified by the HbA 1c level (11,14,35), we were unable to examine the potential effect modification by HbA 1c on the relationship between severe hypoglycemia and all-cause mortality/CVD incidence because the medical claims of Taiwan's NHI program do not include laboratory data such as HbA 1c .…”

Section: Methodological Concerns and Conclusionmentioning

confidence: 94%

“…The DCCT/EDIC study did not directly examine the effect of severe hypoglycemia on CV outcomes or all-cause mortality. A report from the DCCT/EDIC even showed that severe hypoglycemia was associated with the progression of atherosclerosis in those patients with HbA 1c ,7.5% (14). Hyperglycemia and hypoglycemia may both contribute to the progression of CVD pathology.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study of T2DM found a weakly inverse association between the annualized number of hypoglycemic episodes and the risk of death (11,12). By contrast, some studies find that repeated hypoglycemia may be an aggravating factor to atherosclerosis in T1DM (13,14). Studies on the compromised sympatheticadrenal reaction in patients with repeated hypoglycemia have been inconclusive regarding whether such a reaction may further damage intravascular coagulation and thrombosis (15) or decrease the vulnerability of these patients to adverse health outcomes (12).…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

Shen

et al. 2016

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVEThis study investigated the effects of severe hypoglycemia on risks of all-cause mortality and cardiovascular disease (CVD) incidence in patients with type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODSTwo nested case-control studies with age-and sex-matched control subjects and using the time-density sampling method were performed separately within a cohort of 10,411 patients with T1DM in Taiwan. The study enrolled 564 nonsurvivors and 1,615 control subjects as well as 743 CVD case subjects and 1,439 control subjects between 1997 and 2011. History of severe hypoglycemia was identified during 1 year, 1-3 years, and 3-5 years before the occurrence of the study outcomes. Conditional logistic regression analyses were performed to estimate the odds ratio (OR) and 95% CI of the study outcomes. RESULTSPrior severe hypoglycemic events within 1 year were associated with higher risks of all-cause mortality and CVD (adjusted OR 2.74 [95% CI 1.96-3.85] and 2.02 [1.35-3.01], respectively). Events occurring within 1-3 years and 3-5 years before death were also associated with adjusted ORs of 1.94 (95% CI 1.39-2.71) and 1.68 (1.15-2.44), respectively. Significant dose-gradient effects of severe hypoglycemia frequency on mortality and CVD were observed within 5 years. CONCLUSIONSAlthough the CVD incidence may be associated with severe hypoglycemic events occurring in the previous year, the risk of all-cause mortality was associated with severe hypoglycemic events occurring in the preceding 5 years. Exposure to repeated severe hypoglycemic events can lead to higher risks of mortality and CVD.Cardiovascular disease (CVD) is the major cause of death for patients with type 1 diabetes mellitus (T1DM) (1). Although intensive glycemic control reportedly has long-term beneficial effects on CVD onset in T1DM (2), hypoglycemic events often accompany such strategy and must be addressed simultaneously.

show abstract

Section: Comparison With Previous Studiessupporting

confidence: 80%

Section: Methodological Concerns and Conclusionmentioning

confidence: 94%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Shen

et al. 2016

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…These hemodynamic changes are accompanied by an increase in elasticity of large blood vessels and a fall in central arterial pressure, with both measures being diminished in young men with type 1 diabetes of long duration (.15 years) in whom arterial stiffness has developed (18). A recent analysis of coronary artery calcification scores in patients with type 1 diabetes suggested an association of higher scoresdindicating a higher degree of calcification and hence arterial stiffnessdwith a higher rate of severe hypoglycemia (19). Progressive arterial stiffness in people with diabetes allows the reflected arterial pressure wave to return to the central aorta and heart more quickly, arriving during diastole instead of systole, which may compromise coronary filling.…”

Section: Cardiovascular Effects Of Hypoglycemiamentioning

confidence: 99%

Hypoglycemia and Cardiovascular Risk: Is There a Major Link?

2016

View full text Add to dashboard Cite

Severe hypoglycemia is recognized to be one of the strongest predictors of macrovascular events, adverse clinical outcomes, and mortality in patients with type 2 diabetes. However, it is uncertain whether a direct pathophysiological link exists or whether hypoglycemia is primarily a marker of vulnerability to these events. Large clinical trials have reported an increased hazard ratio for all-cause mortality and cardiovascular events in patients with type 2 diabetes and severe hypoglycemia, but such an association has not been demonstrated in prospective trials of people with type 1 diabetes. Several cardiovascular effects occur during hypoglycemia either as a result of low blood glucose levels per se or through activation of the sympathoadrenal response: hemodynamic changes with an increase in cardiac work load and potential attenuation of myocardial perfusion, electrophysiological changes that may be arrhythmogenic, induction of a prothrombotic state, and release of inflammatory markers. Although the potential for a causal relationship has been demonstrated in mechanistic studies, the evidence from large prospective studies that hypoglycemia is a major causal contributor to cardiovascular events is limited to date. Other preexisting cardiovascular risk factors in addition to hypoglycemia may be the major link to the final cardiovascular event, but a low blood glucose level can trigger these events in patients with a high cardiovascular risk.

show abstract

Pancreatectomy, Islet Cell Transplantation, and Nutrition Considerations

et al. 2020

View full text Add to dashboard Cite

Pancreatic islet transplantation is a reliable approach for treating insulin-deficient diabetes. This established β-cell replacement approach has shown considerable improvements in the last 2 decades. It has helped achieve metabolic homeostasis and safe outcomes for a subset of patients with type 1 diabetes and severe pancreatitis. Nutrition support, until recently, was considered as a secondary factor, merely identified as a means of providing all the necessary nutrients for such patients. However, new literature suggests that several factors, such as the route, timing, quantity, and composition of all the nutrients administered, have key diseasealtering properties and are vital during the perioperative management of such patients. This review will highlight the benefits of performing the clinical islet transplantation on a subgroup of patients with type 1 diabetes and pancreatitis and summarize new data that identify the pivotal role of nutrition support as a critical intervention in their management.

show abstract

Severe hypoglycemia and coronary artery calcification during the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study

Abstract: Our results suggest a cumulative effect of hypoglycemic events on cardiovascular risk. They provide a possible link between above mentioned contradictory reports. Our findings support the relevance of personalizing glycemic goals in diabetes management beyond HbA1C.

Cited by 37 publications

References 47 publications

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

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

Hypoglycemia and Cardiovascular Risk: Is There a Major Link?

Pancreatectomy, Islet Cell Transplantation, and Nutrition Considerations

Contact Info

Product

Resources

About