Worse diabetes severity increases risk for mortality after severe hypoglycemia
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Diabetes Severity Score is the only factor significantly linked to greater mortality risk among older adults with type 2 diabetes experiencing severe hypoglycemia, according to study data published in Diabetes & Vascular Disease Research.
“No single baseline characteristic appears to be strongly associated with mortality following severe hypoglycemia in those with type 2 diabetes, including the presence of established cardiovascular disease and HbA1c,” Sam M. Pearson, MBCHB, MRCP, a diabetes research fellow at the Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, U.K., told Healio. “The strongest predictor for mortality appears to be [the] Diabetes Severity Score, which incorporates both biochemical and clinical data, indicating those at the greatest risk of death have the highest burden of glycemia-related complication and, as such, clinicians should not be reassured simply by well-controlled diabetes defined by HbA1c.”
Pearson and colleagues conducted an exploratory post hoc analysis of a randomized controlled trial in which adults with type 2 diabetes who had an episode of severe hypoglycemia requiring emergency services assistance in the area of Leeds in the U.K. were randomly assigned to a nurse-led intervention or standard care. The analysis included participants from both groups. Data surrounding mortality were collected through electronic health records, and cause of death was confirmed using death certificates. Participants were stratified into subgroups using Diabetes Severity Score. The score ranged from one to four, with four indicating the greatest diabetes severity.
Researchers included 124 adults in the analysis, with 60 randomly assigned to the intervention group (55% men; mean age, 74.2 years; mean HbA1c, 7.5%) and 64 randomly assigned to standard care (57.8% men; mean age, 74.8 years; mean HbA1c, 7.6%).
In univariate analysis, Diabetes Severity Score, insulin use and age were significantly correlated with mortality following severe hypoglycemia, whereas no associations were found with CVD at baseline, duration of diabetes, baseline HbA1c, presenting capillary blood glucose, or antiplatelet, antihypertensive and statin therapy.
In multivariate analysis, those with a Diabetes Severity Score of three or four had an increased risk for mortality following severe hypoglycemia compared with those with a score of one or two (adjusted HR = 3.63; 95% CI, 1.78-7.3; P < .001). No other significant associations were observed.
Half of the participants in the standard care group died during the analysis compared with one-third of the intervention participants. The primary cause of death for all participants was infection, followed by CVD. The standard care group had a greater percentage of CVD deaths compared with the intervention group (18.8% vs. 1.7%; P = .002).
“We believe this data provides important insights into the characteristics of patients suffering from severe hypoglycemia in the community and their relationship with mortality,” Pearson said. “Moving forward, our work suggests that those with type 2 diabetes who suffer a hypoglycemic episode should have thorough holistic assessment of their diabetes and related complications and be offered a structured intervention with the aim of reducing further hypoglycemia and possibly other hard endpoints, including death.”
Pearson added that there is a lack of research examining interventions for adults with type 2 diabetes who have a severe hypoglycemic episode. He said large randomized controlled trials exploring new types of interventions, such as those involving continuous glucose monitoring, are needed.
For more information:
Sam M. Pearson, MBCHB, MRCP, can be reached at sampearson1@nhs.net.
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