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Evidence Linking Hypoglycemic Events to an Increased Risk of Acute Cardiovascular Events in Patients With Type 2 Diabetes

Johnston, Stephen S., Conner, Christopher, Aagren, Mark, Smith, David M., Bouchard, Jonathan, Brett, Jason
Diabetes care 2011 v.34 no.5 pp. 1164-1170
algorithms, comorbidity, coronary vessels, geography, health services, hypoglycemia, insurance, models, myocardial infarction, noninsulin-dependent diabetes mellitus, odds ratio, patients, regression analysis, retrospective studies, risk, risk factors, sociodemographic characteristics
OBJECTIVE: This retrospective study examined the association between ICD-9-CM-coded outpatient hypoglycemic events (HEs) and acute cardiovascular events (ACVEs), i.e., acute myocardial infarction, coronary artery bypass grafting, revascularization, percutaneous coronary intervention, and incident unstable angina, in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Data were derived from healthcare claims for individuals with employer-sponsored primary or Medicare supplemental insurance. A baseline period (30 September 2006 to 30 September 2007) was used to identify eligible patients and collect information on their clinical and demographic characteristics. An evaluation period (1 October 2007 to 30 September 2008) was used to identify HEs and ACVEs. Patients aged ≥18 years with type 2 diabetes were selected for analysis by a modified Healthcare Effectiveness Data and Information Set algorithm. Data were analyzed with multiple logistic regression and backward stepwise selection (maximum P = 0.01) with adjustment for important confounding variables, including age, sex, geography, insurance type, comorbidity scores, cardiovascular risk factors, diabetes complications, total baseline medical expenditures, and prior ACVEs. RESULTS: Of the 860,845 patients in the analysis set, 27,065 (3.1%) had ICD-9-CM-coded HEs during the evaluation period. The main model retained 17 significant independent variables. Patients with HEs had 79% higher regression-adjusted odds (HE odds ratio [OR] 1.79; 95% CI 1.69-1.89) of ACVEs than patients without HEs; results in patients aged ≥65 years were similar to those for the entire population (HE OR 1.78, 95% CI 1.65-1.92). CONCLUSIONS: ICD-9-CM-coded HEs were independently associated with an increased risk of ACVEs. Further studies of the relationship between hypoglycemia and the risk of ACVEs are warranted.