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Erschienen in: Endocrine 1/2019

18.08.2018 | Original Article

Cause-specific risk of major adverse cardiovascular outcomes and hypoglycemic in patients with type 2 diabetes: a multicenter prospective cohort study

verfasst von: Bao Sun, Fazhong He, Lei Sun, Jiecan Zhou, Jiayi Shen, Jing Xu, Bin Wu, Rong Liu, Xingyu Wang, Heng Xu, Xiaoping Chen, Honghao Zhou, Zhaoqian Liu, Wei Zhang

Erschienen in: Endocrine | Ausgabe 1/2019

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Abstract

Purpose

Glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) was identified to account for the risk of cardiovascular diseases in type 2 diabetic patients, but no study evaluated the risk based on both HbA1c and FPG levels. We described the risk of major adverse cardiovascular events (MACE) and hypoglycemic in type 2 diabetic patients according to both HbA1c and FPG levels.

Methods

With the usage of databases of Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), 1815 patients from 61 centers in China was identified and grouped according to the criterion value of HbA1c and FPG: Good glycemic control (HbA1c < 6.5%, FPG < 6.1 mmol/L); Insufficient glycemic control (HbA1c < 6.5%, FPG ≥ 6.1 mmol/L or HbA1c ≥ 6.5%, FPG < 6.1 mmol/L); Poor glycemic control (HbA1c ≥ 6.5%, FPG ≥ 6.1 mmol/L). Time-varying multivariable Cox proportional hazards models were employed.

Results

Average age was 64.8 ± 5.8 years, with a median of 4.8 years of follow-up. Overall, the incidence rates of MACE were 20.6 per 1000-person-years in Good glycemic control compared with 45.9 per 1000-person-years in Insufficient glycemic control (adjusted hazard ratio (aHR): 1.99; 95% CI 1.11–3.56; p = 0.02) and 54.7 per 1000-person-years in Poor glycemic control (aHR: 2.46; 95% CI 1.38–4.40; p = 0.002), respectively. The risk of hypoglycemic was highest in Insufficient glycemic control; 67.3 per 1000-person-years compared with 46.3 per 1000-person-years in Good glycemic control (aHR: 1.62; 95% CI 1.03–2.56; p = 0.04). Apart from this, we also observed that both MACE (aHR:1.41; 95% CI 1.13–1.77; p = 0.003) and hypoglycemic episodes (aHR: 1.82; 95% CI 1.48–2.24; p < 0.001) were sufficiently more frequent in the insulin-exposed group than the non-exposed group. In a post-hoc analysis, the risk of MACE (aHR:1.43; 95% CI 1.09–1.86; p = 0.01) and hypoglycemic (aHR: 1.99; 95% CI 1.46–2.69; p < 0.001) were more pronounced in Insufficient glycemic control with insulin exposure.

Conclusions

We observed a significant association of cause-specific risk of MACE and hypoglycemic with Insufficient glycemic control, particularly with insulin exposure.
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Metadaten
Titel
Cause-specific risk of major adverse cardiovascular outcomes and hypoglycemic in patients with type 2 diabetes: a multicenter prospective cohort study
verfasst von
Bao Sun
Fazhong He
Lei Sun
Jiecan Zhou
Jiayi Shen
Jing Xu
Bin Wu
Rong Liu
Xingyu Wang
Heng Xu
Xiaoping Chen
Honghao Zhou
Zhaoqian Liu
Wei Zhang
Publikationsdatum
18.08.2018
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 1/2019
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-018-1715-0

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