Severe hypoglycemia symptoms, antecedent behaviors, immediate consequences and association with glycemia medication usage: Secondary analysis of the ACCORD clinical trial data

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• 作者：Denise E Bonds (1)
  Michael E Miller (2)
  Jim Dudl (3)
  Mark Feinglos (4)
  Faramarz Ismail-Beigi (5)
  Saul Malozowski (6)
  Elizabeth Seaquist (7)
  Debra L Simmons (8)
  Ajay Sood (9)
  
• 关键词：Hypoglycemia ; Type 2 diabetes
• 刊名：BMC Endocrine Disorders
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：12
• 期：1
• 全文大小：183KB
• 参考文献：1. Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, Band MM, Reekie G, Leese GP: Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. / Diabet Med 2005,22(6):749-55. CrossRef
  2. Leese GP, Wang J, Broomhall J, Kelly P, Marsden A, Morrison W, Frier BM, Morris AD: Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. / Diabetes Care 2003,26(4):1176-180. CrossRef
  3. Johnson ES, Koepsell TD, Reiber G, Stergachis A, Platt R: Increasing incidence of serious hypoglycemia in insulin users. / J Clin Epidemiol 2002,55(3):253-59. CrossRef
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  5. Buse JB, Bigger JT, Byington RP, Cooper LS, Cushman WC, Friedewald WT, Genuth S, Gerstein HC, Ginsberg HN, Goff DC, / et al.: Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. / Am J Cardiol 2007,99(12A):21i-33i. CrossRef
  6. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH, / et al.: Effects of intensive glucose lowering in type 2 diabetes. / N Engl J Med 2008,358(24):2545-559. CrossRef
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  9. Gerstein HC, Riddle MC, Kendall DM, Cohen RM, Goland R, Feinglos MN, Kirk JK, Hamilton BP, Ismail-Beigi F, Feeney P: Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. / Am J Cardiol 2007,99(12A):34i-43i. CrossRef
  10. Bonds DE, Kurashige EM, Bergenstal R, Brillon D, Domanski M, Felicetta JV, Fonseca VA, Hall K, Hramiak I, Miller ME, / et al.: Severe hypoglycemia monitoring and risk management procedures in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. / Am J Cardiol 2007,99(12A):80i-89i. CrossRef
  11. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, Childress RD, Craven TE, Cuddihy RM, Dailey G, / et al.: The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. / BMJ 2010, 340:b5444. CrossRef
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  19. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6823/12/5/prepub
  
• 作者单位：Denise E Bonds (1)
  Michael E Miller (2)
  Jim Dudl (3)
  Mark Feinglos (4)
  Faramarz Ismail-Beigi (5)
  Saul Malozowski (6)
  Elizabeth Seaquist (7)
  Debra L Simmons (8)
  Ajay Sood (9)
  
  1. National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD, USA
  2. Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
  3. Care Management Institute, Kaiser Permanente, Oakland, CA, USA
  4. Department of Medicine, Duke University Medical Center, Durham, NC, USA
  5. Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
  6. Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
  7. Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
  8. Division of Medicine, Endocrinology, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, AR, USA
  9. Division of Endocrinology, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
  

文摘

Background Hypoglycemia is a common complication of diabetes treatment. This paper describes symptoms, predecessors, consequences and medications associated with the first episode of severe hypoglycemia among ACCORD participants with type 2 diabetes, and compares these between intensive (Int: goal A1C <6.0%) and standard (Std, goal A1C 7-.9%) glycemia intervention groups. Methods Information about symptoms, antecedents, and consequences was collected at the time participants reported an episode of severe hypoglycemia. Data on medications prescribed during the clinical trial was used to determine the association of particular diabetes drug classes and severe hypoglycemia. Results The most frequently reported symptoms in both glycemia group were weakness/fatigue (Int 29%; Std 30%) and sweating (Int 26%; Std 27%), followed by confusion/disorientation (Int 22%; Std 29%) and shakiness (Int 21%; Std 19%). Approximately half of all events were preceded by a variation in food intake (Int 48%; Std 58%). The most common consequences were confusion (Int 37%; Std 34%), loss of consciousness (Int 25%; Std 25%), and hospitalization (Int 18%; Std 24%). The highest rates of hypoglycemia were found among those participants treated with insulin only (Int 6.09/100 person yrs; Std 2.64/100 person yrs) while the lowest were among those prescribed oral agents only (Int 1.93/100 person yrs; Std 0.20/100 person yrs). Conclusions Severe hypoglycemia episodes were frequently preceded by a change in food intake, making many episodes potentially preventable. Symptoms of confusion/disorientation and loss of consciousness were frequently seen. The highest rates of hypoglycemia were seen with prescription of insulin, either alone or in combination with other medications. Clinical Trial Registration Number: NCT00000620