HbA1c and Risk of Severe Hypoglycemia in Type 2 Diabetes
Open Access
- 15 October 2013
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 36 (11), 3535-3542
- https://doi.org/10.2337/dc13-0610
Abstract
OBJECTIVE: We examined the association between HbA1c level and self-reported severe hypoglycemia in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Type 2 diabetic patients in a large, integrated healthcare system, who were 30–77 years of age and treated with glucose-lowering therapy, were asked about severe hypoglycemia requiring assistance in the year prior to the Diabetes Study of Northern California survey conducted in 2005–2006 (62% response rate). The main exposure of interest was the last HbA1c level collected in the year preceding the observation period. Poisson regression models adjusted for selected demographic and clinical variables were specified to evaluate the relative risk (RR) of severe hypoglycemia across HbA1c levels. We also tested whether the HbA1c-hypoglycemia association differed across potential effect modifiers (age, diabetes duration, and category of diabetes medication). RESULTS: Among 9,094 eligible survey respondents (mean age 59.5 ± 9.8 years, mean HbA1c 7.5 ± 1.5%), 985 (10.8%) reported experiencing severe hypoglycemia. Across HbA1c levels, rates of hypoglycemia were 9.3–13.8%. Compared with those with HbA1c of 7–7.9%, the RR of hypoglycemia was 1.25 (95% CI 0.99–1.57), 1.01 (0.87–1.18), 0.99 (0.82–1.20), and 1.16 (0.97–1.38) among those with HbA1c <6, 6–6.9, 8–8.9, and ≥9%, respectively, in a fully adjusted model. Age, diabetes duration, and category of diabetes medication did not significantly modify the HbA1c-hypoglycemia relationship. CONCLUSIONS: Severe hypoglycemia was common among patients with type 2 diabetes across all levels of glycemic control. Risk tended to be higher in patients with either near-normal glycemia or very poor glycemic control.Keywords
This publication has 37 references indexed in Scilit:
- Epidemiologic Relationships Between A1C and All-Cause Mortality During a Median 3.4-Year Follow-up of Glycemic Treatment in the ACCORD TrialDiabetes Care, 2010
- The Association Between the Number of Prescription Medications and Incident Falls in a Multi-ethnic Population of Adult Type-2 Diabetes Patients: The Diabetes and Aging StudyJournal of General Internal Medicine, 2009
- Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes MellitusJAMA, 2009
- Glucose Control and Vascular Complications in Veterans with Type 2 DiabetesThe New England Journal of Medicine, 2009
- National Trends in Treatment of Type 2 Diabetes Mellitus, 1994-2007Archives of Internal Medicine, 2008
- Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 DiabetesThe New England Journal of Medicine, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visitsBMC Endocrine Disorders, 2008
- Cohort Profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population†International Journal of Epidemiology, 2008
- Diabetes-Related Complications, Glycemic Control, and Falls in Older AdultsDiabetes Care, 2008