Poor glycemic control a risk for hypoglycemia

January 01, 0001

Poor glycemic control a risk for hypoglycemia

In another post-hoc epidemiological analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, these US and Canadian investigators sought links between baseline characteristics and HbA1C levels with risk of hypoglycemia. The ACCORD trial was a large multicenter trial looking at intensive versus normal glycemic control regimens in uncontrolled diabetics.

The authors write: "The annual incidence of hypoglycaemia was 3.14% in the intensive treatment group and 1.03% in the standard glycaemia group. We found significantly increased risks for hypoglycaemia among women, African- Americans, those with less than a high school education, aged participants, and those who used insulin at trial entry. For every 1% unit decline in the haemoglobin A1C concentration from baseline to 4 month visit, there was a 28% and 14% reduced risk of hypoglycaemia requiring medical assistance in the standard and intensive groups, respectively. In both treatment groups, the risk of hypoglycaemia requiring medical assistance increased with each 1% unit increment in the average updated haemoglobin A1C concentration (standard arm- hazard ratio 1.76, intensive arm- hazard ratio 1.15."

The authors concluded: "A greater drop in haemoglobin A1C concentration from baseline to the 4 month visit was not associated with an increased risk for hypoglycaemia. Patients with poorer glycaemic control had a greater risk of hypoglycaemia, irrespective of treatment group. Identification of baseline subgroups with increased risk for severe hypoglycaemia can provide guidance to clinicians attempting to modify patient therapy on the basis of individual risk."

This study sheds important light on the risks of hypoglycemia and may help physicians at increased risk.

For the full abstract, click here.

BMJ 340:b5444, 8 January 2010 © 2010 Miller et al.
The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia- post hoc epidemiological analysis of the ACCORD study. Michael E Miller, Denise E Bonds, Hertzel C Gerstein et al.. Correspondence to: ME Miller: [email protected]

Category: T. Endocrine/Metabolic/Nutritional. Keywords: diabetes, baseline characteristics, hypoglycemia, Hb A1c, ACCORD study, retrospective epidemiological analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 26 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care