Severe hypoglycemia and the risk of end stage renal disease in type 2 diabetes

Abstract

We investigated the association between the incidence of severe hypoglycemia and the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes. Baseline and follow-up data for 988,333 participants with type 2 diabetes were retrieved from the National Health Insurance System database. The number of severe hypoglycemia episodes experienced from 2007 to 2009 was determined. The primary outcome was the development of ESRD after the baseline evaluation. Participants were followed from the baseline until death or December 31, 2016, during this period 14,545 participants (1.5%) developed ESRD. In the crude model, compared with those who experienced no severe hypoglycemia, the hazard ratios (95% confidential intervals) for developing ESRD were 4.96 (4.57-5.39), 6.84 (5.62-8.32), and 9.51 (7.14-12.66) in participants who experienced one, two, and three or more episodes of severe hypoglycemia, respectively. Further adjustment for various confounding factors attenuated the association between severe hypoglycemia and ESRD; the significance of the association between severe hypoglycemia and ESRD was maintained. Having three or more severe hypoglycemia episodes was associated with a nearly two-fold increased risk of developing ESRD. Prior episodes of severe hypoglycemia were associated with an increased risk of ESRD among Korean adults with type 2 diabetes.

Figure 1

The association between severe hypoglycemia and outcomes by time since index date. All HRs adjusted for covariates including age, sex, smoking, alcohol consumption, regular exercise, living place (urban or rural), income level, BMI, hypertension, dyslipidemia, chronic kidney disease, urine protein, anti-diabetic drugs, diabetes duration, fasting plasma glucose, LDL-cholesterol, and major comorbidities (malignancy, liver cirrhosis, and chronic obstructive pulmonary disease).

Figure 2

Subgroup analysis for the association between recurrent severe hypoglycemia and end-stage renal disease. All HRs adjusted for covariates including age, sex, smoking, alcohol consumption, regular exercise, living place (urban or rural), income level, BMI, hypertension, dyslipidemia, chronic kidney disease, urine protein, anti-diabetic drugs, diabetes duration, fasting plasma glucose, LDL-cholesterol, and major comorbidities (malignancy, liver cirrhosis, and chronic obstructive pulmonary disease).