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. 2019 Jan;21(1):1-5.
doi: 10.1089/dia.2018.0362. Epub 2018 Dec 21.

The Association of Biochemical Hypoglycemia with the Subsequent Risk of a Severe Hypoglycemic Event: Analysis of the DCCT Data Set

Roy W Beck  1 , Richard M Bergenstal  2 , Tonya D Riddlesworth  1 , Craig Kollman  1
Affiliations

The Association of Biochemical Hypoglycemia with the Subsequent Risk of a Severe Hypoglycemic Event: Analysis of the DCCT Data Set

Roy W Beck et al. Diabetes Technol Ther. 2019 Jan.

Abstract

Objective: To evaluate the association of biochemical hypoglycemia with subsequent severe hypoglycemia (SH) events using the Diabetes Control and Complications Trial (DCCT) data set.

Research design and methods: The frequency of biochemical hypoglycemia (percentage of values <70 and <54 mg/dL [3.9 and 3.0 mmol/L) was assessed using DCCT blood glucose concentrations measured at a central laboratory from seven finger-stick samples (7-point testing: pre- and 90-min postmeals and at bedtime) collected during 1 day every 3 months. SH events required a change in mental status necessitating the involvement of another individual to provide treatment. A Poisson model accounting for repeated measures from each participant was used to assess the association of biochemical hypoglycemia frequency, computed from the 7-point finger-stick data, with the development of SH events.

Results: The risk of SH during a 3-month period was substantially higher (P < 0.001) when there was at least one hypoglycemic blood glucose value in the preceding 7-point profile, with similar results seen for both the 70 mg/dL (rate ratio = 3.0 [95% confidence interval: 2.6-3.3]) and 54 mg/dL (rate ratio = 2.7 [95% confidence interval: 2.4-3.1]) thresholds.

Conclusions: The occurrence of biochemical hypoglycemia <70 or <54 mg/dL is associated with an increased risk of SH. For this reason as well as the deleterious effects of hypoglycemia on glucose counter-regulation and hypoglycemia awareness, cognition, quality of life, and arrhythmias, it is important in diabetes management to avoid hypoglycemic glucose levels as much as possible.

Keywords: Biochemical hypoglycemia; Risk assessment; Severe hypoglycemia; Type 1 diabetes..

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Conflict of interest statement

R.W.B., T.D.R., and C.K. have no personal disclosures, but report that their institution has received research funding or study supplies from Abbott, Ascenia, Bigfoot, Dexcom, Roche, Tandem, and consulting fees from Insulet and Lilly. R.M.B. has no personal disclosures, but reports that his employer, the nonprofit Health Partners Institute, contracts for his services, which includes research support, consulting, or scientific advisory board participation for Abbott Diabetes Care, Becton Dickinson, Dexcom, Eli Lilly, Glooko, Hygieia, Johnson & Johnson, Medtronic, Merck, Novo Nordisk, Roche, and Sanofi.

Figures

<b>FIG. 1.</b>
FIG. 1.
Frequency of ≥1 SH event in a 3-month period according to the number of hypoglycemia blood glucose values in the preceding profile. SH, severe hypoglycemia.
See this image and copyright information in PMC

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