Increased Mortality of Patients With Diabetes Reporting Severe Hypoglycemia
Diabetes Care, 07/05/2012
McCoy RG et al. – Self–report of severe hypoglycemia is associated with 3.4–fold increased risk of death. Patient–reported outcomes, including patient–reported hypoglycemia, may therefore augment risk stratification and disease management of patients with diabetes.Methods
- Adult patients (N=1,020) seen in a specialty diabetes clinic between August 2005 and July 2006 were questioned about frequency of hypoglycemia during a preencounter interview; 7 were lost to follow–up and excluded from analysis.
- Mild hypoglycemia was defined as symptoms managed without assistance, and severe hypoglycemia was defined as symptoms requiring external assistance.
- Mortality data, demographics, clinical characteristics, and Charlson comorbidity index (CCI) were obtained from the electronic medical record after 5years.
- Patients were stratified by self–report of hypoglycemia at baseline, demographics were compared using the two–sample t test, and risk of death was expressed as odds ratio (95% CI).
- Associations were controlled for age, sex, diabetes type and duration, CCI, HbA1c, and report of severe hypoglycemia.
- In total, 1,013 patients with type 1 (21.3%) and type 2 (78.7%) diabetes were questioned about hypoglycemia.
- Among these, 625 (61.7%) reported any hypoglycemia, and 76 (7.5%) reported severe hypoglycemia.
- After 5years, patients who reported severe hypoglycemia had 3.4–fold higher mortality (95% CI 1.5–7.4; P=0.005) compared with those who reported mild/no hypoglycemia.