Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial
PublisherAmerican Diabetes Association Inc.
MetadataShow full item record
AbstractOBJECTIVE 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 ± 9.0 years) with suboptimally controlled type 2 diabetes (HbA 1c 9.4 ± 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. © 2018 by the American Diabetes Association.
SponsorsThe authors thank Carlos Abraira (Miami VA Hospital and University of Miami), Madeline McCarren (Pharmacy Benefits Management, VA Hospital, Hines, IL), and William Henderson (University of Colorado) for playing instrumental roles in the conceptualization and design of the VADT. This study was supported by the VA Cooperative Studies Program (CSP #465 and CSP #465-F), Department of Veterans Affairs Office of Research and Development, the American Diabetes Association, and the National Eye Institute.
KeywordVeterans Affairs Diabetes Trial
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85059094213&doi=10.2337%2fdc18-1144&partnerID=40&md5=90d72fe72c3cefb96e4c0793172bb52b; http://hdl.handle.net/10713/8637
- A Link Between Hypoglycemia and Progression of Atherosclerosis in the Veterans Affairs Diabetes Trial (VADT).
- Authors: Saremi A, Bahn GD, Reaven PD, Veterans Affairs Diabetes Trial (VADT).
- Issue date: 2016 Mar
- Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial.
- Authors: Zhou JJ, Schwenke DC, Bahn G, Reaven P, VADT Investigators.
- Issue date: 2018 Oct
- Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.
- Authors: Hayward RA, Reaven PD, Wiitala WL, Bahn GD, Reda DJ, Ge L, McCarren M, Duckworth WC, Emanuele NV, VADT Investigators.
- Issue date: 2015 Jun 4
- Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2: Veterans Affairs Diabetes Trial.
- Authors: Abraira C, Duckworth W, McCarren M, Emanuele N, Arca D, Reda D, Henderson W, VA Cooperative Study of Glycemic Control and Complications in Diabetes Mellitus Type 2.
- Issue date: 2003 Nov-Dec
- Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.
- Authors: Abraira C, Colwell J, Nuttall F, Sawin CT, Henderson W, Comstock JP, Emanuele NV, Levin SR, Pacold I, Lee HS
- Issue date: 1997 Jan 27