Context: HbA1C is an important predictor of severe hypoglycemia.
Objective: To determine the association of proximal HbA1C level with first hypoglycemia requiring hospitalization (HH) in adults with incident type 2 diabetes (T2D).
Design, Setting, and Participants: A nested case-control study was designed using linked data from the Clinical Practice Research Datalink and Hospital Episode Statistics in England in 1997-2014. The first hypoglycemia as primary diagnosis for hospitalization after T2D diagnosis was identified. Proximal HbA1C was measured within 90 days prior to the first HH.
Main Outcome Measure: Odds ratio (OR) for developing HH.
Results: The association of proximal HbA1C level with first HH was similar between HbA1C of 6.0% (OR 1.54; 95% CI 1.12-2.11) and 9.0% (1.48 [1.01-2.17]), compared to the reference HbA1C level of 7.0%. For proximal HbA1C level of 4.0-6.5%, every additional 0.5% increase in HbA1C was associated with lower first HH risk with OR (95% CI) ranging between 0.37 (0.20-0.67) and 0.86 (0.76-0.98). For proximal HbA1C level of 8.0-11.5%, every additional 0.5% increase in HbA1C was associated with higher first HH risk with OR (95% CI) ranging between 1.16 (1.04-1.29) and 1.34 (1.18-1.52). The U-shaped association between proximal HbA1C level and first HH did not exist among current sulfonylureas users but persisted among current insulin users (Pinteraction=0.002). Among current non-insulin non-sulfonylureas users who had first HH, 78% took insulin or sulfonylureas prior to HH.
Conclusions: Having either poor or near-normal HbA1C was associated with higher risk of first HH in T2D within three months.
|投稿者||Zhong, Victor W; Juhaeri, Juhaeri; Cole, Stephen R; Shay, Christina M; Gordon-Larsen, Penny; Kontopantelis, Evangelos; Mayer-Davis, Elizabeth J|
|組織名||From the Department of Nutrition, Gillings School of Global Public Health,;University of North Carolina, Chapel Hill, NC, USA.;Department of Preventive Medicine, Northwestern University Feinberg School of;Medicine, Chicago, Illinois, USA.;Global Pharmacovigilance and Epidemiology, Sanofi, Bridgewater, NJ, USA.;Department of Epidemiology, Gillings School of Global Public Health, University;of North Carolina, Chapel Hill, NC, USA.;Center for Health Metrics and Evaluation, the American Heart Association, Dallas,;TX, USA.;Carolina Population Center, University of North Carolina at Chapel Hill, Chapel;Hill, NC, USA.;Department of Medicine, School of Medicine, University of North Carolina, Chapel;Farr Institute for Health Informatics Research, University of Manchester,;Manchester, UK.|