High rates of non-severe hypoglycaemia linked to cardiovascular events in type 2 diabetes
People with type 2 diabetes who experience high rates of non-severe hypoglycaemia should be identified to try to reduce their risk of cardiovascular events, researchers have said.
The study, from the University of Sheffield and Novo Nordisk in Denmark, set out to investigate the link between non-severe hypoglycaemia episodes (NSHEs) and severe hypoglycaemic episodes in people with type 2 diabetes.
The team also wanted to examine the possible association between NSHEs and major adverse cardiac events (MACE).
They carried out post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial, looking at whether the annual rate of NSHEs was associated with:
- Time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person)
- Time to first MACE
- Time to cardiovascular death
- Time to all-cause mortality.
The team, led by Dr Elaine Chow from the University of Sheffield, found that “there is an association between NSHEs (2–11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for.
“Additionally, while no association was found between participants with 2–11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]).”
They concluded: “The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes.
“Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs.”