Assessing Vascular Disease Risk Associated with Medication-Related Hypoglycemia


Zhao Y, Campbell CR, Fonseca V, Shi L. Impact of hypoglycemia associated with antihyperglycemic medications on vascular risks in veterans with type 2 diabetes.
Diabetes Care. 2012;35(5):1126-1132. 

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Zhao and colleagues examined the impact of hypoglycemia associated with antihyperglycemic medications on vascular risk among veterans with type 2 diabetes in a retrospective cohort study.  

Subjects aged ≥18 years with type 2 diabetes who were prescribed antihyperglycemic medications were identified in the Veterans Health Administration (VHA) Veterans Integrated Service Network 16 (VISN 16). Date of new antihyperglycemic medication prescription was considered the index date; those with hypoglycemia and cardiovascular or microvascular diseases within 1 year prior to the index date were excluded. A matched control group was used for comparisons.  

The main outcomes examined—cardiovascular events (myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease), microvascular complications (renal, ophthalmic, or neurologic complications related to diabetes), and all-cause death—were assessed using Kaplan-Meier analysis and Cox proportional hazards regression models.  

Results:  

  • Three-year CVD incidence rate was 30.65/100 patients vs 17.48/100 patients in the hypoglycemia and control groups, respectively. Those in the hypoglycemia group had an increased likelihood of developing CVD vs those in the control group (P<0.0001). Subjects in the hypoglycemia group were also at higher risk for having stroke, congestive heart failure, and peripheral vascular disease (P<0.05 for all); myocardial infarction risk was not significantly different between groups.  
  • Three-year incidence rate of microvascular complications was 34.46/100 patients vs 22.03/100 patients in the hypoglycemia and control groups, respectively. Those in the hypoglycemia group had an increased likelihood of developing microvascular complications vs those in the control group (P<0.0001).  
  • When data were controlled for confounding variables, subjects in the hypoglycemia group still demonstrated higher risk of CVD events and microvascular complications vs those in the control group. In particular, those in the hypoglycemia group were 2.58 times more likely to have peripheral vascular disease, 2.25 times more likely to have a stroke, and 1.73 times as likely to have a vascular event (any CVD and microvascular complication) vs controls.  

 

July 2012 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest. 

Related content:  

Read more about this study and additional cutting-edge diabetes data in the May 2012 issue of Clinical Insights® in Diabetes. Click here. 

Vascular Risk Associated with Medication-Related Hypoglycemia: Design  

Cumulative Incidence of CVD: Hypoglycemia Group vs Control  

Cumulative Incidence of Microvascular Complications: Hypoglycemia Group vs Control  

Last Modified: 11/15/2013