Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial

Stephen N. Davis, William Duckworth, Nicholas Emanuele, Rodney A. Hayward, Wyndy L. Wiitala, Lizy Thottapurathu, Domenic J. Reda, Peter D. Reaven

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE To determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS This post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 6 9.0 years) with suboptimally controlled type 2 diabetes (HbA 1c 9.4 6 2.0%) of 11.5 6 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA 1c <7.0%) versus standard (HbA 1c <8.5%) glucose control. RESULTS The rate of severe hypoglycemia in the intensive treatment group was 10.3 per 100 patient-years compared with 3.7 per 100 patient-years in the standard treatment group (P < 0.001). In multivariable analysis, insulin use at baseline (P = 0.02), proteinuria (P = 0.009), and autonomic neuropathy (P = 0.01) were independent risk factors for severe hypoglycemia, and higher BMI was protective (P = 0.017). Severe hypoglycemia within the past 3 months was associated with an increased risk of serious cardiovascular events (P = 0.032), cardiovascular mortality (P = 0.012), and total mortality (P = 0.024). However, there was a relatively greater increased risk for total mortality in the standard group compared with the intensive group (P = 0.019). The association between severe hypoglycemia and cardiovascular events increased significantly as overall cardiovascular risk increased (P = 0.012). CONCLUSIONS Severe hypoglycemic episodes within the previous 3 months were associated with increased risk for major cardiovascular events and cardiovascular and all-cause mortality regardless of glycemic treatment group assignment. Standard therapy further increased the risk for all-cause mortality after severe hypoglycemia.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalDiabetes Care
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Veterans
Hypoglycemia
Mortality
Therapeutics
Proteinuria
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Research Design
Cardiovascular Diseases
Insulin
Glucose

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Davis, S. N., Duckworth, W., Emanuele, N., Hayward, R. A., Wiitala, W. L., Thottapurathu, L., ... Reaven, P. D. (2019). Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. Diabetes Care, 42(1), 157-163. https://doi.org/10.2337/dc18-1144

Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. / Davis, Stephen N.; Duckworth, William; Emanuele, Nicholas; Hayward, Rodney A.; Wiitala, Wyndy L.; Thottapurathu, Lizy; Reda, Domenic J.; Reaven, Peter D.

In: Diabetes Care, Vol. 42, No. 1, 01.01.2019, p. 157-163.

Research output: Contribution to journalArticle

Davis, SN, Duckworth, W, Emanuele, N, Hayward, RA, Wiitala, WL, Thottapurathu, L, Reda, DJ & Reaven, PD 2019, 'Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial', Diabetes Care, vol. 42, no. 1, pp. 157-163. https://doi.org/10.2337/dc18-1144
Davis SN, Duckworth W, Emanuele N, Hayward RA, Wiitala WL, Thottapurathu L et al. Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. Diabetes Care. 2019 Jan 1;42(1):157-163. https://doi.org/10.2337/dc18-1144
Davis, Stephen N. ; Duckworth, William ; Emanuele, Nicholas ; Hayward, Rodney A. ; Wiitala, Wyndy L. ; Thottapurathu, Lizy ; Reda, Domenic J. ; Reaven, Peter D. / Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. In: Diabetes Care. 2019 ; Vol. 42, No. 1. pp. 157-163.
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abstract = "OBJECTIVE To determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS This post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 6 9.0 years) with suboptimally controlled type 2 diabetes (HbA 1c 9.4 6 2.0{\%}) of 11.5 6 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA 1c <7.0{\%}) versus standard (HbA 1c <8.5{\%}) glucose control. RESULTS The rate of severe hypoglycemia in the intensive treatment group was 10.3 per 100 patient-years compared with 3.7 per 100 patient-years in the standard treatment group (P < 0.001). In multivariable analysis, insulin use at baseline (P = 0.02), proteinuria (P = 0.009), and autonomic neuropathy (P = 0.01) were independent risk factors for severe hypoglycemia, and higher BMI was protective (P = 0.017). Severe hypoglycemia within the past 3 months was associated with an increased risk of serious cardiovascular events (P = 0.032), cardiovascular mortality (P = 0.012), and total mortality (P = 0.024). However, there was a relatively greater increased risk for total mortality in the standard group compared with the intensive group (P = 0.019). The association between severe hypoglycemia and cardiovascular events increased significantly as overall cardiovascular risk increased (P = 0.012). CONCLUSIONS Severe hypoglycemic episodes within the previous 3 months were associated with increased risk for major cardiovascular events and cardiovascular and all-cause mortality regardless of glycemic treatment group assignment. Standard therapy further increased the risk for all-cause mortality after severe hypoglycemia.",
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AU - Davis, Stephen N.

AU - Duckworth, William

AU - Emanuele, Nicholas

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AU - Wiitala, Wyndy L.

AU - Thottapurathu, Lizy

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N2 - OBJECTIVE To determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS This post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 6 9.0 years) with suboptimally controlled type 2 diabetes (HbA 1c 9.4 6 2.0%) of 11.5 6 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA 1c <7.0%) versus standard (HbA 1c <8.5%) glucose control. RESULTS The rate of severe hypoglycemia in the intensive treatment group was 10.3 per 100 patient-years compared with 3.7 per 100 patient-years in the standard treatment group (P < 0.001). In multivariable analysis, insulin use at baseline (P = 0.02), proteinuria (P = 0.009), and autonomic neuropathy (P = 0.01) were independent risk factors for severe hypoglycemia, and higher BMI was protective (P = 0.017). Severe hypoglycemia within the past 3 months was associated with an increased risk of serious cardiovascular events (P = 0.032), cardiovascular mortality (P = 0.012), and total mortality (P = 0.024). However, there was a relatively greater increased risk for total mortality in the standard group compared with the intensive group (P = 0.019). The association between severe hypoglycemia and cardiovascular events increased significantly as overall cardiovascular risk increased (P = 0.012). CONCLUSIONS Severe hypoglycemic episodes within the previous 3 months were associated with increased risk for major cardiovascular events and cardiovascular and all-cause mortality regardless of glycemic treatment group assignment. Standard therapy further increased the risk for all-cause mortality after severe hypoglycemia.

AB - OBJECTIVE To determine the risk factors for severe hypoglycemia and the association between severe hypoglycemia and serious cardiovascular adverse events and cardiovascular and all-cause mortality in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS This post hoc analysis of data from the VADT included 1,791 military veterans (age 60.5 6 9.0 years) with suboptimally controlled type 2 diabetes (HbA 1c 9.4 6 2.0%) of 11.5 6 7.5 years disease duration with or without known cardiovascular disease and additional cardiovascular risk factors. Participants were randomized to intensive (HbA 1c <7.0%) versus standard (HbA 1c <8.5%) glucose control. RESULTS The rate of severe hypoglycemia in the intensive treatment group was 10.3 per 100 patient-years compared with 3.7 per 100 patient-years in the standard treatment group (P < 0.001). In multivariable analysis, insulin use at baseline (P = 0.02), proteinuria (P = 0.009), and autonomic neuropathy (P = 0.01) were independent risk factors for severe hypoglycemia, and higher BMI was protective (P = 0.017). Severe hypoglycemia within the past 3 months was associated with an increased risk of serious cardiovascular events (P = 0.032), cardiovascular mortality (P = 0.012), and total mortality (P = 0.024). However, there was a relatively greater increased risk for total mortality in the standard group compared with the intensive group (P = 0.019). The association between severe hypoglycemia and cardiovascular events increased significantly as overall cardiovascular risk increased (P = 0.012). CONCLUSIONS Severe hypoglycemic episodes within the previous 3 months were associated with increased risk for major cardiovascular events and cardiovascular and all-cause mortality regardless of glycemic treatment group assignment. Standard therapy further increased the risk for all-cause mortality after severe hypoglycemia.

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