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HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care

OBJECTIVE: To establish whether low HbA1c is associated with clinical hypoglycaemia among people with type 2 diabetes prescribed insulins or sulphonylureas. DESIGN: Retrospective cohort study using routine electronic GP health records collected between January 2013 and December 2015. SETTING: Three...

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Autores principales: Malawana, Manil, Kerry, Sally, Mathur, Rohini, Robson, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041855/
https://www.ncbi.nlm.nih.gov/pubmed/30013791
http://dx.doi.org/10.1177/2054270418773669
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author Malawana, Manil
Kerry, Sally
Mathur, Rohini
Robson, John
author_facet Malawana, Manil
Kerry, Sally
Mathur, Rohini
Robson, John
author_sort Malawana, Manil
collection PubMed
description OBJECTIVE: To establish whether low HbA1c is associated with clinical hypoglycaemia among people with type 2 diabetes prescribed insulins or sulphonylureas. DESIGN: Retrospective cohort study using routine electronic GP health records collected between January 2013 and December 2015. SETTING: Three east London Clinical Commissioning Groups. PARTICIPANTS: Two cohorts of adults with type 2 diabetes prescribed either (i) insulins with or without other oral antidiabetic medication (n = 6788, 36.4%) or (ii) sulphonylureas with or without other oral antidiabetic medications excluding insulins (n = 11,840, 63.6%). MAIN OUTCOME MEASURES: First clinically recorded hypoglycaemia and all-cause mortality. Hazard ratios (HR) adjusting for age, ethnicity, renal function and comorbidities were calculated using Cox regression models. RESULTS: Compared with an HbA1c of 53–63 mmol/mol, the adjusted HR of hypoglycaemia in those with a low HbA1c, below 53 mmol/mol, in the insulin and sulphonylurea cohorts were 1.26 (95% CI, 0.97 to 1.62) and 1.54 (95% CI, 1.27 to 1.87), respectively. Adjusted HRs of all-cause mortality from low HbA1c in the insulin and sulphonylurea cohorts were 1.54 (95% CI, 1.15 to 2.07) and 1.42 (95% CI, 1.11 to 1.81), respectively. Increasing age and renal impairment were also associated with increased hypoglycaemic risk in both cohorts. CONCLUSIONS: HbA1c below 53 mmol/mol was associated with episodes of clinical hypoglycaemia among people with type 2 diabetes prescribed sulphonylureas, and all-cause mortality in those prescribed insulins and sulphonylureas. These findings support the need for reviewing glycaemic targets and the intensities of treatment in those with low HbA1c prescribed insulins or sulphonylureas to reduce the risk of hypoglycaemia.
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spelling pubmed-60418552018-07-16 HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care Malawana, Manil Kerry, Sally Mathur, Rohini Robson, John JRSM Open Research Paper OBJECTIVE: To establish whether low HbA1c is associated with clinical hypoglycaemia among people with type 2 diabetes prescribed insulins or sulphonylureas. DESIGN: Retrospective cohort study using routine electronic GP health records collected between January 2013 and December 2015. SETTING: Three east London Clinical Commissioning Groups. PARTICIPANTS: Two cohorts of adults with type 2 diabetes prescribed either (i) insulins with or without other oral antidiabetic medication (n = 6788, 36.4%) or (ii) sulphonylureas with or without other oral antidiabetic medications excluding insulins (n = 11,840, 63.6%). MAIN OUTCOME MEASURES: First clinically recorded hypoglycaemia and all-cause mortality. Hazard ratios (HR) adjusting for age, ethnicity, renal function and comorbidities were calculated using Cox regression models. RESULTS: Compared with an HbA1c of 53–63 mmol/mol, the adjusted HR of hypoglycaemia in those with a low HbA1c, below 53 mmol/mol, in the insulin and sulphonylurea cohorts were 1.26 (95% CI, 0.97 to 1.62) and 1.54 (95% CI, 1.27 to 1.87), respectively. Adjusted HRs of all-cause mortality from low HbA1c in the insulin and sulphonylurea cohorts were 1.54 (95% CI, 1.15 to 2.07) and 1.42 (95% CI, 1.11 to 1.81), respectively. Increasing age and renal impairment were also associated with increased hypoglycaemic risk in both cohorts. CONCLUSIONS: HbA1c below 53 mmol/mol was associated with episodes of clinical hypoglycaemia among people with type 2 diabetes prescribed sulphonylureas, and all-cause mortality in those prescribed insulins and sulphonylureas. These findings support the need for reviewing glycaemic targets and the intensities of treatment in those with low HbA1c prescribed insulins or sulphonylureas to reduce the risk of hypoglycaemia. SAGE Publications 2018-07-06 /pmc/articles/PMC6041855/ /pubmed/30013791 http://dx.doi.org/10.1177/2054270418773669 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc/4.0/ Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Research Paper
Malawana, Manil
Kerry, Sally
Mathur, Rohini
Robson, John
HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title_full HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title_fullStr HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title_full_unstemmed HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title_short HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
title_sort hba1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041855/
https://www.ncbi.nlm.nih.gov/pubmed/30013791
http://dx.doi.org/10.1177/2054270418773669
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