Effect of Severe Hypoglycemia on Ischemic Heart Disease during ~ 30 Years of DCCT/EDIC Follow-up

What is it about?

We analyzed an at-baseline young and generally healthy type 1 diabetes cohort, the DCCT cohort, with no cardiovascular complications but mild to moderate microvascular complications, namely retinopathy. This cohort was followed for roughly 30 years. With our analysis, we show for the first time that the effect of severe hypoglycemia on ischemic heart disease (IHD) in a young type 1 diabetes cohort is modified by markers of baseline microvascular disease severity. With increasing baseline duration of diabetes, retinopathy severity level, or Diabetes Complication Severity Index (DCSI), the effect of severe hypoglycemia expressed by the hazard ratio for IHD based on severe hypoglycemia becomes stronger. We found that severe hypoglycemia was a significant ischemic heart disease factor for young type 1 diabetes patients who presented with longer diabetes duration, higher retinopathy severity levels, or higher DCSI levels.

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Photo by Akash Deep on Unsplash

Photo by Akash Deep on Unsplash

Why is it important?

Our analysis highlights the importance of treating both glycemic control and severe hypoglycemia as cardiovascular risk factors in diabetes and managing them accordingly. Just recently, although in type 2 diabetes, it has been emphasized that special attention should be directed toward severe hypoglycemia reduction in the older diabetes population with comorbidity. We now show for the first time that this special attention needs to include younger type 1 diabetes individuals with microvascular disease, namely retinopathy, to reduce ischemic heart disease risk.

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