Severe hypoglycaemia and Type 1 diabetes
To examine whether previous severe hypoglycaemic events were associated with the risk of all-cause mortality after major cardiovascular events (myocardial infarction or stroke) in patients with Type 1 diabetes.
This study used data from the Swedish National Diabetes Register, linked to patient-level hospital records, prescription data, and death records. We selected patients with Type 1 diabetes who visited a clinic 2002-2010 and experienced a major cardiovascular complication after their clinic visit.
We estimated a two-part model for all-cause mortality following a major cardiovascular event: logistic regression for death within the first month; and a Cox proportional hazards model conditional on one month survival. At age 60, 5-year cumulative mortality risk was estimated from the models for patients with and without prior diabetes complications. 1,839 patients experienced major cardiovascular events, of whom; 403 had previously experienced severe hypoglycaemic events; and 703 died within our study period. A prior hypoglycaemic event was associated with a significant increase in mortality following a cardiovascular event, with hazard ratios estimated at 1.79 (95% CI 1.37-2.35) within the first month and 1.25 (95% CI 1.02-1.53) after one-month. Patients with prior hypoglycaemia had an estimated 5-year cumulative mortality risk of 52.2% (95% CI 45.3% - 59.5%) and 39.8% (95% CI 33.4% - 46.3%) for MI and stroke, respectively.
We have found evidence patients with Type 1 diabetes in Sweden with prior severe hypoglycaemic events have increased risk of mortality following a cardiovascular event.
Bjorn Eliasson (Institute of Medicines, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden)
Dr William H. Herman (The Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48105, United States)
Professor Andrew Palmer (The Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS 7000, Australia)
Ann-Marie Svensson (Institute of Medicines, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden)
National Health and Medical Research Council Project Grant, National Health and Medical Research Council Capacity Building Grant