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Early cardiovascular risk and all-cause mortality following an incident of severe hypoglycaemia: A Population-based Cohort Study

Shih-Chang Lo, Edy Kornelius, Jing-Yang Huang, Yung-Rung Lai, Chien-Ning Huang, Yi-Sun Yang, Jeng-Yuan Chiou
Diabetes, Obesity & Metabolism 2019 April 11

OBJECTIVE: Severe hypoglycaemia is associated with a high risk of cardiovascular events in patient with diabetes. The aim of this study is to clarify the temporal relationship between hypoglycaemia and cardiovascular events.

RESEARCH DESIGN AND METHODS: This observational cohort study was conducted using Taiwan's Longitudinal Cohort of Diabetes Patients Database, which included 360,000 patients with newly diagnosed diabetes for the period 1999 to 2001. Patients with the first severe hypoglycaemia after 2002 served as the study cohort. Each patient in the study cohort was matched with two control patients without severe hypoglycaemia, based on their propensity score. Joinpoint regression model was used to determine trends in all-cause mortality and incidence of cardiovascular disease (CVD) events in both cohorts.

RESULTS: A total of 10,157 patients with severe hypoglycaemia and 20,314 matched controls were recruited in this study. Patients with severe hypoglycaemia had a significantly higher risk of CVD (HR, 7.28; 95% CI, 5.19-10.20) and all-cause mortality (HR, 19.92; 95% CI, 13.42-29.56) in the first month compared with those without. For patients with severe hypoglycaemia, the incidence of CVDs dropped 17.29% monthly in the first four months and slowly decreased (-0.67%) in the subsequent months. All-cause mortality decreased by 16.55% and 3.24% monthly in 0-6 months and 6-17 months, respectively.

CONCLUSIONS: Severe hypoglycaemia is associated with a greater risk of cardiovascular events and death, especially in the first month after the hypoglycaemic episode. Patients prone to severe hypoglycaemia should be made aware of the elevated risk of subsequent cardiovascular events.


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