Hypoglycemia may initiate ‘cascade of negative consequences’
medwireNews: Findings from the Hypo-RESOLVE study suggest that exposure to hypoglycemia is associated with subsequent negative clinical outcomes in people with diabetes, supporting a key role for hypoglycemia prevention.
As reported at the virtual 57th EASD Annual Meeting, the researchers analyzed pooled clinical trial data from 22,071 people with diabetes who experienced a total of 890,350 hypoglycemic events during an average of approximately 1 year of follow-up.
Joseph O'Reilly (University of Edinburgh, UK) told delegates that hypoglycemia event rates per person–year were higher among the 6976 people with type 1 diabetes than the 15,095 with type 2 diabetes, at 87.3 versus 24.9. This finding remained consistent when hypoglycemic events were categorized into level 1 (blood glucose 3.0 to <3.9 mmol/L [54–70 mg/dL]), level 2 (<3.0 mmol/L), or level 3 (requiring third-party assistance).
Using logistic regression analysis, the investigators identified a “clear association” between the number of hypoglycemic events in the previous 45 days and subsequent occurrence of hypoglycemia in the following 45 days.
For instance, people with any hypoglycemic event had a significantly higher risk for subsequent hypoglycemia than those without, with an odds ratio (OR) of 1.26 in both type 1 and type 2 diabetes. These associations remained consistent across all categories of hypoglycemia severity, with ORs ranging from 1.04 to 1.46 for type 1 diabetes and from 1.08 to 1.46 for type 2 diabetes.
In the second part of their study, O’Reilly and colleagues used time-to-event analysis to evaluate the occurrence of adverse events following hypoglycemia.
“It is important to note that exposure to events of any severity was associated with subsequent severe hypoglycemia,” said O’Reilly. ORs for the association between an any-grade or level 1–2 hypoglycemic event and a future level 3 event ranged from 2.53 to 3.24 for type 1 diabetes and from 2.85 to 3.30 for type 2 diabetes.
In people with type 2 diabetes, O’Reilly reported that level 2 and level 3 hypoglycemic events were “strongly associated” with subsequent cardiovascular disease (CVD) events, with significant ORs of 1.36 and 1.97, respectively. Level 1, level 2, and any-grade hypoglycemia events were also significantly associated with subsequent neuropathy risk, at corresponding ORs of 1.58, 1.56, and 1.72.
The presenter noted a “possible association” between level 3 hypoglycemic events and subsequent CVD risk in people with type 1 diabetes, but the OR of 1.32 did not reach statistical significance, and there were no other associations between hypoglycemic events and adverse clinical outcomes in this population.
Taken together, the Hypo-RESOLVE findings suggest that “exposure to any hypoglycemia could […] elevate the risk of a cascade of negative consequences,” concluded O’Reilly.
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