Optum Epidemiology, Boston, Massachusetts.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Diabetes Obes Metab. 2017 Oct;19(10):1425-1435. doi: 10.1111/dom.13000. Epub 2017 Jul 21.
Certain treatments for type 2 diabetes mellitus cause hypoglycaemia and weight gain, and thus might counteract the benefits of intensive glucose control. We quantify the association of cardiovascular disease (CVD) outcomes with hypoglycaemia and weight gain among patients with type 2 diabetes treated with sulfonylureas.
This cohort study included patients from January 2009 through December 2014 who were selected from within a deidentified nationwide electronic health records repository, including multiple provider networks and electronic medical records systems. Hypoglycaemia measures from structured data fields and free text clinical notes were categorized as serious or non-serious. Covariate adjusted Poisson regression analysis was used to assess the association between frequency of hypoglycaemia (by severity), or magnitude of weight change, and incidence of acute myocardial infarction (AMI), congestive heart failure (CHF) and stroke.
Among 143 635 eligible patients, we observed 5669 cases of AMI, 14 109 incident cases of CHF and 7017 cases of stroke. Overall incidence rates were 1.53, 4.26 and 1.92 per 100 person-years for AMI, CHF and stroke, respectively. The associations between overall hypoglycaemia and each of the CVD outcomes were positive, with stronger associations observed for serious hypoglycaemia and attenuated or null associations observed for non-serious hypoglycaemia. Weight change exhibited a U-shaped association with increased risks associated with both weight loss and weight gain relative to stable weight.
This study provides evidence of increased CVD risk associated with hypoglycaemia, especially with serious hypoglycaemia events. While associations were attenuated with non-serious hypoglycaemia, the results were suggestive of a potential increased risk.
某些 2 型糖尿病的治疗方法会导致低血糖和体重增加，从而可能抵消强化血糖控制的益处。我们量化了 2 型糖尿病患者使用磺酰脲类药物治疗时，低血糖和体重增加与心血管疾病（CVD）结局的相关性。
这项队列研究纳入了 2009 年 1 月至 2014 年 12 月期间从一个匿名的全国性电子健康记录库中选择的患者，该记录库包括多个医疗机构网络和电子病历系统。从结构化数据字段和自由文本临床记录中提取低血糖测量值，并将其分为严重或非严重。使用协方差调整泊松回归分析评估低血糖（严重程度）的频率或体重变化幅度与急性心肌梗死（AMI）、充血性心力衰竭（CHF）和中风的发生率之间的关联。
在 143635 名符合条件的患者中，我们观察到 5669 例 AMI、14109 例新发 CHF 和 7017 例中风。AMI、CHF 和中风的总发生率分别为每 100 人年 1.53、4.26 和 1.92。总体低血糖与每种 CVD 结局之间均呈正相关，严重低血糖的相关性更强，而非严重低血糖的相关性减弱或为零。体重变化与体重减轻和体重增加与稳定体重相比，风险增加呈 U 形相关。
这项研究提供了与低血糖相关的 CVD 风险增加的证据，尤其是与严重低血糖事件相关。虽然非严重低血糖的相关性减弱，但结果提示可能存在潜在的风险增加。
