Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes

Li, Tsai‐Chung; Kardia, Sharon L.R.; Li, Chia Ing; Chen, Ching Chu; Liu, Chiu Shong; Yang, Sing Yu; Muo, Chin Shin; Peyser, Patricia A.; Lin, Cheng Chieh

doi:10.1016/j.metabol.2015.05.004

Cited by 23 publications

(14 citation statements)

References 35 publications

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“…The most important pathogenesis leading to microvascular damage is that hyperglycemia damages capillary endothelial cells in the retina, mesangial cells in the renal glomeruli and Schwan cells of the peripheral [13]. Due to hyperglycemia, there is excess glucose transport in these endothelial cells which leads to damage of these cells.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of duration, hypertension and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital

Ramanathan¹

2017

Integr Mol Med

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Aim: To evaluate microvascular complications in Diabetes Mellitus (DM) and to study correlation of Microvascular Complication with duration of diabetes, glycemic control and hypertension in a tertiary care centre. Though the study is not uncommon there are very few published reports on correlation of all three factors (together in the same study) with microvascular complications of diabetes mellitus. Materials and methods:Design: Retrospective, observational study. The study has been done through 2007 to 2009 in general hospital, Ahmedabad, India and comprises of 500 patients with Diabetes Mellitus with detailed history, physical examination and laboratory investigations including vibration perception test/ electromyography/nerve conduction velocity, fundus examination and urine for microalbuminuria/urine for protein.Results: Diabetic Retinopathy was the most common complication observed in the present study with prevalence of 42% (210/500) followed by Diabetic Neuropathy with a prevalence of 38% (190/500) and Diabetic Nephropathy with a prevalence of 35% (175/500). Diabetic Retinopathy, Neuropathy and Nephropathy all were associated with poor glycemic control. 190/210 (90%) patients of Diabetic Retinopathy, 175/190 (92%) patients of Diabetic Neuropathy and all 175 patients of Diabetic Nephropathy had associated hypertension. 85/210 (40%) patients of Diabetic Retinopathy had duration between 10-15 years, 115/210 (55%) patients of Diabetic Retinopathy had a duration of >15 years, 70/190 (37%) patients of Diabetic Neuropathy had duration of DM 10-15 years and 70/190 (37%) patients had duration of DM >15years. 95/175 (54%) patients of Diabetic Nephropathy had a duration of DM >15 years. 70% diabetic patients with no microvascular complications had duration of diabetes <5 years while 83% diabetic patients with no microvascular complications had HbA1c < 7.0%. Conclusion:In our experience, long duration of Diabetes, poor glycemic control and associated hypertension all increased the chances of microvascular complications of diabetes.

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Section: Discussionmentioning

confidence: 99%

“…Due to hyperglycemia, there is excess glucose transport in these endothelial cells which leads to damage of these cells. Thus, microvascular complications arises as a result of damage inside these endothelial cells [13,14].…”

Section: Discussionmentioning

confidence: 99%

Correlation of duration, hypertension and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital

Ramanathan¹

2017

Integr Mol Med

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“…Many prior studies also did not compare hospitalization risk in persons with prediabetes or undiagnosed diabetes (23–32) or evaluate potential differences by age, sex, and race (23–27,30,31). Our study had a median follow-up period of 20 years in a community-based population, and we were able to rigorously characterize and compare hospitalization risk among those with diagnosed diabetes by levels of HbA 1c and in those at high risk prior to a formal diagnosis of diabetes (prediabetes and undiagnosed diabetes).…”

Section: Discussionmentioning

confidence: 99%

Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study

et al. 2016

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OBJECTIVETo examine the magnitude and types of hospitalizations among persons with prediabetes, undiagnosed diabetes, and diagnosed diabetes.RESEARCH DESIGN AND METHODSThis study included 13,522 participants in the Atherosclerosis Risk in Communities (ARIC) study (mean age 57 years, 56% female, 24% black, 18% with prediabetes, 4% with undiagnosed diabetes, 9% with diagnosed diabetes) with follow-up in 1990–2011 for hospitalizations. Participants were categorized by diabetes/HbA1c status: without diagnosed diabetes, HbA1c <5.7% (reference); prediabetes, 5.7 to <6.5%; undiagnosed diabetes, ≥6.5%; and diagnosed diabetes, <7.0 and ≥7.0%.RESULTSDemographic adjusted rates per 1,000 person-years of all-cause hospitalizations were higher with increasing diabetes/HbA1c category (Ptrend < 0.001). Persons with diagnosed diabetes and HbA1c ≥7.0% had the highest rates of hospitalization (3.1 times higher than those without a history of diagnosed diabetes, HbA1c <5.7%, and 1.5 times higher than those with diagnosed diabetes, HbA1c <7.0%, P < 0.001 for both comparisons). Persons with undiagnosed diabetes had 1.6 times higher rates of hospitalization and those with prediabetes had 1.3 times higher rates of hospitalization than those without diabetes and HbA1c <5.7% (P < 0.001 for both comparisons). Rates of hospitalization by diabetes/HbA1c category were different by race (Pinteraction = 0.011) and by sex (Pinteraction = 0.020). There were significantly excess rates of hospitalizations due to cardiovascular, endocrine, respiratory, gastrointestinal, iatrogenic/injury, neoplasm, genitourinary, neurologic, and infection causes among those with diagnosed diabetes compared with those without a history of diagnosed diabetes (all P < 0.05).CONCLUSIONSPersons with diagnosed diabetes, undiagnosed diabetes, and prediabetes are at a significantly elevated risk of hospitalization compared with those without diabetes. Substantial excess rates of hospitalizations in persons with diagnosed diabetes were for endocrine, infection, and iatrogenic/injury causes, which may be preventable with improved diabetes care.

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“…This finding may be explained by a lower risk of severe hypoglycemic events when A1c levels are maintained at a higher range. Recently, it has been reported that a higher A1c level was associated with a lower one-year risk of hospitalization due to hypoglycemia [30]. Hypoglycemia is a major adverse consequence of glucose lowering therapy and older patients are at a significantly higher risk due to multiple co-morbidities, polypharmacy (≥5 medications), chronic renal or hepatic impairment, poor nutrition, use of sulfonylurea or insulin, acute illness, hypoglycemic unawareness and diminished counter regulatory responses [31].…”

Section: Discussionmentioning

confidence: 99%

Tighter glycemic control is associated with ADL physical dependency losses in older patients using sulfonylureas or mitiglinides: Results from the DIMORA study

Abbatecola

Armellini³

et al. 2015

Metabolism

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Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes

Cited by 23 publications

References 35 publications

Correlation of duration, hypertension and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital

Correlation of duration, hypertension and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital

Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study

Tighter glycemic control is associated with ADL physical dependency losses in older patients using sulfonylureas or mitiglinides: Results from the DIMORA study

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