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Severe hypoglycemia risk twice as high for black vs. white adults
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Black adults with diabetes have nearly double the incidence rate for severe hypoglycemia compared with white adults; other risk factors for severe hypoglycemia include increasing age, diabetes medication use and microalbuminuria, study data show.
“Identifying risk factors for hypoglycemia is important for clinical care and yet has been understudied,” Alexandra Lee, PhD, MSPH, of Johns Hopkins Bloomberg School of Public Health, told Endocrine Today. “Despite the American Diabetes Association’s recommendation that risk of hypoglycemia be assessed when treating older adults with diabetes, there is no standard, accepted set of risk factors for severe hypoglycemia.”
Lee and colleagues evaluated data from the Atherosclerosis Risk in Communities (ARIC) study on 1,206 adults (mean age, 64 years; 32% black; 54% women) with diabetes to evaluate risk factors for severe hypoglycemia.
During a median follow-up of 15.2 years, 185 severe hypoglycemia events occurred. Black adults had nearly double the incidence rate for severe hypoglycemia compared with white adults.
Risk factors for severe hypoglycemia included age (per 5 years, HR = 1.24; 95% CI, 1.07-1.43), black race (HR = 1.39; 95% CI, 1.02-1.88), diabetes medications (insulin vs. no medications, HR = 3; 95% CI, 1.71-5.28; oral medications only vs. no medications, HR = 2.2; 95% CI, 1.28-3.76), glycemic control (moderate vs. good, HR = 1.78; 95% CI, 1.11-2.83; poor vs. good, HR = 2.62; 95% CI, 1.67-4.1), microalbuminuria (HR = 1.95; 95% CI, 1.23-3.07) and poor cognitive function (HR = 1.57; 95% CI, 1.33-1.84) after multivariable adjustment.
Severe hypoglycemia was also associated with having trouble with activities of daily living (HR = 1.95; 95% CI, 1.41-2.69), having Medicaid insurance (HR = 1.7; 95% CI, 1.14-2.53) and using antidepressants (HR = 1.83; 95% CI, 1.11-3.04). Levels of 1,5-anhydroglucitol were linearly associated with severe hypoglycemia (HR per 5 µg/mL = 1.22; 95% CI, 1.05-1.41).
“Our study confirmed several ‘traditional’ risk factors and identified several ‘nontraditional’ risk factors for severe hypoglycemia, taking a step towards defining a standard set of risk factors,” Lee said. “Of note, we found that blacks had two times higher incidence rate of severe hypoglycemia compared to whites. Additionally, higher average glycemia, as measured by fructosamine, and higher glycemic variability, as measured by 1,5-anhydroglucitol, were associated with increased risk of severe hypoglycemia, suggesting that those with poor control and unstable glycemia are at highest risk of hypoglycemia. To use these newly identified risk factors in clinical settings, further studies are needed to determine which set of risk factors best discriminates between people at low and high risk of severe hypoglycemia.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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