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Cover of Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes - A Systematic Review of the Evidence

Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes - A Systematic Review of the Evidence

Evidence-based Synthesis Program

Investigators: Hanna E Bloomfield, MD, MPH, Nancy Greer, PhD, David Newman, MD, Roderick MacDonald, MS, Maureen Carlyle, MPH, Patrick Fitzgerald, MPH, and Indulis Rutks, BS. Minneapolis VA Medical Center ESP Director: Timothy J Wilt, MD, MPH.

Washington (DC): Department of Veterans Affairs; 2012 Apr.
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Excerpt

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Although people with diabetes have a substantially increased risk of cardiovascular disease (CVD), recent trials show that intensive glucose lowering does not reduce the risk of CVD death or all-cause mortality although it reduces the risk of microvascular complications (nephropathy, retinopathy and neuropathy) and possibly non-fatal myocardial infarction. Intensive glucose control also increases the risk of hypoglycemic episodes. Several recent meta-analyses of the trials comparing intensive to conventional glucose control concluded that intensive control is associated with a 2–2.5 fold increased risk of severe hypoglycemia. The reviews however have not included smaller randomized trials, trials focused on the comparison of specific drug regimens, and non-randomized trials. We conducted the current review to provide broader insight into the incidence of, the risk factors for, and the clinical and social impact of severe hypoglycemia in adults with type 2 diabetes treated with glucose lowering medications.

Contents

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, M.D., M.P.H., Director.

Suggested citation:

Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P, Rutks I, and Wilt, TJ. Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes – A Systematic Review of the Evidence. VA-ESP Project #09-009; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.

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