title: Severe hypoglycemia identifies vulnerable patients with type 2 diabetes at risk for premature death and all-site cancer: the Hong Kong diabetes registry.
abstract: OBJECTIVE We examined the associations of clinical profiles in type 2 diabetic patients who developed severe hypoglycemia and their clinical outcomes, including death and all-site cancer. RESEARCH DESIGN AND METHODS A consecutive cohort of 8,767 type 2 diabetic patients with and without severe hypoglycemia in the 12 months before enrollment were recruited between 1995 and 2007, with follow-up until 2009. Severe hypoglycemia was defined by ICD-9 codes as hospitalizations resulting from hypoglycemia. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% CIs of clinical factors collected at enrollment for severe hypoglycemia. RESULTS In this cohort, mean age was 57.4 (SD 13.2) years and median disease duration of diabetes was 5 (interquartile range [IQR] 1-11) years. During a median follow-up of 6.71 (IQR 3.47-10.38) years, 235 patients had severe hypoglycemia (incidence 3.96 [95% CI 3.45-4.46] per 1,000 patient-years). At enrollment, patients with and without severe hypoglycemia had similar cancer rates. During follow-up, patients with severe hypoglycemia had a higher incidence of all-site cancer (13.4 vs. 6.4%, P < 0.0001) and mortality (32.8 vs. 11.2%, P < 0.0001) than those without severe hypoglycemia. After adjusting for confounders, old age, low BMI, high glycated hemoglobin, low triglyceride (TG), low LDL cholesterol (LDL-C), albuminuria, and chronic kidney disease were independent predictors for severe hypoglycemia. CONCLUSIONS In type 2 diabetes, severe hypoglycemia is associated with advanced age, renal dysfunction, poor glycemic control, and cancer subphenotypes (low BMI, low LDL-C, and low TG).
authors: Corresponding author: Alice P.S. Kong, alicekong@cuhk.edu.hk.
authors: Alice P S
authors: AP
authors: Kong
authors: Xilin
authors: X
authors: Yang
authors: Andrea
authors: A
authors: Luk
authors: Ronald C W
authors: RC
authors: Ma
authors: Wing Yee
authors: WY
authors: So
authors: Risa
authors: R
authors: Ozaki
authors: Rose
authors: R
authors: Ting
authors: Kitty
authors: K
authors: Cheung
authors: Chung Shun
authors: CS
authors: Ho
authors: Michael H M
authors: MH
authors: Chan
authors: Chun Chung
authors: CC
authors: Chow
authors: Juliana C N
authors: JC
authors: Chan
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index