Brief reportHypoglycaemia and cardiovascular disease in Type 1 Diabetes. Results from the Catalan National Public Health registry on insulin pump therapy
Introduction
Severe hypoglycaemia has recently been associated with an increased risk of adverse cardiovascular outcomes in diabetes [1], [2]. Moreover, repeated hypoglycaemia has recently been claimed to be an aggravating factor for preclinical atherosclerosis in T1D [3].
Recurrent severe hypoglycaemia is usually considered indication for starting therapy with continuous subcutaneous insulin infusion (CSII) [4]. We aimed to evaluate the prevalence of cardiovascular disease (CVD) in patients with and without a history of repeated hypoglycaemia at the time of starting CSII by analysing data from the Catalan National Public Health registry on CSII therapy (CNPH-CSII).
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Material and methods
The CNPH-CSII database (1990–2010) was analysed retrospectively. It included 1550 T1D patients prior starting CSII (aged 34 ± 12 years; 69% women, duration of diabetes 16 ± 9 years; HbA1c 8.2 ± 1.3%; body mass index (BMI 24 ± 5 kg/m2). The percentage of patients in which the main indication for CSII included repeated hypoglycaemia and/or hypoglycaemia unawareness as well as the proportion of patients with any severe episode of hypoglycaemia the year before was obtained. In the registry severe
Results
Repeated hypoglycaemia/hypoglycaemia unawareness was the main indication for CSII in 14.9% of patients whereas a history of severe hypoglycaemia the previous year was present in 34.6%. In 26.9% of patients in which repeated hypoglycaemia and/or hypoglycaemia unawareness was not the main indication for starting CSII there was still a history of repeated severe hypoglycaemia during the year before entry in the registry. Considering the total cohort, CVD was already present in the 4.7% of
Discussion
Results derived from several large randomised clinical trials in T2D have raised the concern that severe hypoglycaemia may increase the risk of CVD morbidity and mortality in patients assigned to an intensive glucose-lowering intervention [2], [5]. More recently, data from healthcare claims for individuals with employer-sponsored primary or Medicare supplemental insurance have suggested an independent association between hypoglycaemia and acute cardiovascular events [6]. Possible explanations
Conflict of interest
There are no conflicts of interest.
Acknowledgment
We are indebted to all of those involved in reporting the data to the Catalan National Public Health registry on CSII therapy.
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