Type 1･2DM患者がインシュリン治療を受けることで低血糖により心血管イベント・死亡のリスクが上昇か。
1. Diabetes Care. 2015 Feb;38(2):316-22. doi: 10.2337/dc14-0920. Epub 2014 Dec 9.
Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study.
Khunti K(1), Davies M(2), Majeed A(3), Thorsted BL(4), Wolden ML(4), Paul SK(5).
Author information: (1)Leicester Diabetes Centre, University of Leicester, Leicester, U.K. Leicester Clinical Trials Unit, University of Leicester, Leicester, U.K. kk22@leicester.ac.uk. (2)Leicester Diabetes Centre, University of Leicester, Leicester, U.K. Leicester Clinical Trials Unit, University of Leicester, Leicester, U.K. (3)Department of Primary Care and Public Health, Imperial College London, London, U.K. (4)Novo Nordisk A/S, Bagsværd, Denmark. (5)Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
OBJECTIVE: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes or type 2 diabetes. RESEARCH DESIGN AND METHODS: This retrospective cohort study used data from the Clinical Practice Research Datalink database and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. RESULTS: In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with type 1 diabetes were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with type 2 diabetes, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with type 1 diabetes were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with type 2 diabetes, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with type 1 and type 2 diabetes. CONCLUSIONS: Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period.
© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
PMID: 25492401 [PubMed - in process]
20150317作成
1. Diabetes Care. 2015 Feb;38(2):316-22. doi: 10.2337/dc14-0920. Epub 2014 Dec 9.
Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study.
Khunti K(1), Davies M(2), Majeed A(3), Thorsted BL(4), Wolden ML(4), Paul SK(5).
Author information: (1)Leicester Diabetes Centre, University of Leicester, Leicester, U.K. Leicester Clinical Trials Unit, University of Leicester, Leicester, U.K. kk22@leicester.ac.uk. (2)Leicester Diabetes Centre, University of Leicester, Leicester, U.K. Leicester Clinical Trials Unit, University of Leicester, Leicester, U.K. (3)Department of Primary Care and Public Health, Imperial College London, London, U.K. (4)Novo Nordisk A/S, Bagsværd, Denmark. (5)Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
OBJECTIVE: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes or type 2 diabetes. RESEARCH DESIGN AND METHODS: This retrospective cohort study used data from the Clinical Practice Research Datalink database and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. RESULTS: In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with type 1 diabetes were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with type 2 diabetes, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with type 1 diabetes were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with type 2 diabetes, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with type 1 and type 2 diabetes. CONCLUSIONS: Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period.
© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
PMID: 25492401 [PubMed - in process]
20150317作成