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dc.contributor.authorDavis, S.N.
dc.contributor.authorDuckworth, W.
dc.contributor.authorEmanuele, N.
dc.date.accessioned2019-03-29T14:47:33Z
dc.date.available2019-03-29T14:47:33Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85059094213&doi=10.2337%2fdc18-1144&partnerID=40&md5=90d72fe72c3cefb96e4c0793172bb52b
dc.identifier.urihttp://hdl.handle.net/10713/8637
dc.description.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.en_US
dc.description.sponsorshipThe 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.en_US
dc.description.urihttps://dx.doi.org/10.2337/dc18-1144en_US
dc.language.isoen_USen_US
dc.publisherAmerican Diabetes Association Inc.en_US
dc.relation.ispartofDiabetes Care
dc.subjectVeterans Affairs Diabetes Trialen_US
dc.subject.meshCardiovascular Diseases--mortalityen_US
dc.subject.meshDiabetes Mellitusen_US
dc.subject.meshHypoglycemia--complicationsen_US
dc.titleEffects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trialen_US
dc.typeArticleen_US
dc.identifier.doi10.2337/dc18-1144
dc.identifier.pmid30455335


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