Ernstige hypoglycemie gelinkt aan slechte klinische eindpunten in DM2
Severe hypoglycemia linked to adverse clinical outcome in Type 2 diabetes
Results from the ADVANCE study show that severe hypoglycemia is associated with increased risk for a variety of adverse outcomes in individuals with Type 2 diabetes.
"It is possible that severe hypoglycemia contributes to adverse outcomes, but these analyses indicate that hypoglycemia is just as likely to be a marker of vulnerability to such events," write the authors in the New England Journal of Medicine.
Sophia Zoungas (University of Sydney, Australia) and fellow investigators from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) study evaluated links between severe hypoglycemia and adverse outcomes, including death and cardiovascular (CV) events, in 11,140 patients with Type 2 diabetes.
The main results from ADVANCE have already been published and reported by MedWire News. The study compared perindopril with indapamide for the treatment of high blood pressure, and intensive (initial gliclazide, target glycated hemoglobin [HbA1c] 6.5% or less) with standard glucose-lowering strategies (target HbA1c below 7.5%).
This substudy focused on risks for hypoglycemia over a median follow-up period of 5 years. During this time 231 (2.1%) of the patients had an episode of severe hypoglycemia, including 150 (2.7%) of the 5571 patients who received intensive and 81 (1.5%) of the 5569 patients who received standard glucose-lowering treatment.
During the follow-up period, severe hypoglycemia (blood glucose lower than 50 mg/dl; 2.8 mmol/l) was associated with a significant 2.88-, 1.81-, 2.68-, and 2.69-fold increased relative risk for major macrovascular (myocardial infarction, stroke, CV death) or microvascular (nephropathy or retinopathy) events, death from CV causes, or death from all-causes, respectively.
The team also noted similar links with a variety of other outcomes including those of a respiratory, digestive, or dermatological nature.
However, no significant associations between repeated severe hypoglycemia episodes and vascular outcomes or death were found.
"Our study shows that severe hypoglycemia is strongly associated with increased risks of a broad range of adverse clinical outcomes in patients with long-standing Type 2 diabetes," say Zoungas et al.
"Although our findings cannot exclude the possibility that severe hypoglycemia has a direct causal link with these outcomes, they suggest that it is as likely to be a marker of vulnerability to a wide range of adverse clinical outcomes."
The researchers conclude: "In either case, the presence of severe hypoglycemia should raise clinical suspicion of the patient's susceptibility to adverse outcomes and prompt action to address this possibility."