Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan.
Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Diabetes Obes Metab. 2019 Aug;21(8):1878-1885. doi: 10.1111/dom.13746. Epub 2019 May 9.
Severe hypoglycaemia is associated with a high risk of cardiovascular events in patient with diabetes. The aim of this study was to clarify the temporal relationship between hypoglycaemia and cardiovascular events.
This observational cohort study was conducted using Taiwan's Longitudinal Cohort of Diabetes Patients Database, which included 360 000 patients with newly diagnosed diabetes during the period 1999 to 2001. Patients with the first severe hypoglycaemia after 2002 served as the study cohort. Each patient in the study cohort was matched with two control patients without severe hypoglycaemia, based on a propensity score. A joinpoint regression model was used to determine trends in all-cause mortality and incidence of cardiovascular disease (CVD) events in both cohorts.
A total of 10 157 patients with severe hypoglycaemia and 20 314 matched controls were recruited. Patients with severe hypoglycaemia had a significantly higher risk of CVD (HR, 7.28; 95% CI, 5.19-10.20) and all-cause mortality (HR, 19.92; 95% CI, 13.42-29.56) during the first month compared with those without. In patients with severe hypoglycaemia, the incidence of CVDs dropped by 17.29% monthly during the first 4 months and slowly decreased (-0.67%) during subsequent months. All-cause mortality decreased by 16.55% and 3.24% monthly during months 0-6 and months 6-17, respectively.
Severe hypoglycaemia is associated with a greater risk of cardiovascular events and death, especially during the first month following a hypoglycaemic episode. Patients prone to severe hypoglycaemia should be made aware of the elevated risk of subsequent cardiovascular events.
严重低血糖与糖尿病患者发生心血管事件的风险增加有关。本研究旨在阐明低血糖与心血管事件之间的时间关系。
本观察性队列研究使用了台湾的糖尿病患者纵向队列数据库，该数据库包括 1999 年至 2001 年期间新诊断为糖尿病的 36 万名患者。将 2002 年后首次发生严重低血糖的患者作为研究队列。研究队列中的每位患者均根据倾向评分与 2 名无严重低血糖的对照患者相匹配。使用 joinpoint 回归模型确定两个队列的全因死亡率和心血管疾病（CVD）事件发生率的趋势。
共纳入 10157 例严重低血糖患者和 20314 例匹配对照。与无严重低血糖的患者相比，严重低血糖患者在第一个月内发生 CVD（HR，7.28；95%CI，5.19-10.20）和全因死亡率（HR，19.92；95%CI，13.42-29.56）的风险显著增加。在严重低血糖患者中，在第 1 至第 4 个月期间，CVD 发病率每月下降 17.29%，随后几个月缓慢下降（-0.67%）。全因死亡率在第 0 至 6 个月和第 6 至 17 个月期间分别每月下降 16.55%和 3.24%。
严重低血糖与心血管事件和死亡风险增加相关，尤其是在发生低血糖事件后的第一个月。易发生严重低血糖的患者应意识到随后发生心血管事件的风险增加。
