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Acta Diabetol. 2019 Nov 21. doi: 10.1007/s00592-019-01447-x. [Epub ahead of print]

Association of severe hypoglycemia with mortality for people with diabetes mellitus during a 20-year follow-up in Denmark: a cohort study.

Author information

1
Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark. mhj@hst.aau.dk.
2
Department of Health Science and Technology, Aalborg University, Fredriks Bajers Vej 7, 9210, Aalborg, Denmark. mhj@hst.aau.dk.
3
Biostatistics, Novo Nordisk A/S, Alfred Nobels Vej 27, 9210, Aalborg, Denmark.
4
Department of Health Science and Technology, Aalborg University, Fredriks Bajers Vej 7, 9210, Aalborg, Denmark.
5
Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
6
Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
7
Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.

Abstract

AIMS:

Severe hypoglycemia has a significant deteriorating effect on quality of life of the individual and has been associated with increased mortality. The aim of this study was to investigate the mortality among people with type 1 and type 2 diabetes suffering from severe hypoglycemia in Denmark in the last two decades.

METHODS:

People diagnosed with type 1 (n = 44,033) and type 2 diabetes (n = 333,581) were extracted from the complete population of Denmark from 1996 to 2017 via ICD-10 diabetes codes and ATC diabetes medication codes. People suffering from severe hypoglycemia (type 1 diabetes n = 8808, type 2 diabetes n = 5605) as identified from ICD-10 codes were then matched 1:1 by year of birth, gender and year of diabetes diagnosis with those without severe hypoglycemia. Cox proportional hazards models were constructed to analyze the effect of severe hypoglycemia on mortality.

RESULTS:

For both people with type 1 (HR 1.11, CI 95% 1.06 to 1.17) and type 2 diabetes (HR 1.77, CI 95% 1.67 to 1.87) suffering from hypoglycemia, an increased mortality risk was observed, compared to people without severe hypoglycemia. An investigation of the death causes did not indicate an association between the severe hypoglycemic episodes and death.

CONCLUSION:

In this study, severe hypoglycemic episodes increased the mortality risk for people with type 1 and type 2 diabetes. The risk was higher among people with type 2 diabetes. Whether severe hypoglycemia is a symptom of other underlying illnesses increasing mortality risk or a risk factor itself needs further investigation.

KEYWORDS:

Denmark; Mortality; Severe hypoglycemia; Type 1 diabetes; Type 2 diabetes

PMID:
31754819
DOI:
10.1007/s00592-019-01447-x

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