Severe Hypoglycemia and Smoking in a Long-Term Type 1 Diabetic Population

Hirai, Flávio E.; Moss, Scot E.; Klein, Barbara E.K.; Klein, Ronald

doi:10.2337/dc06-2264

Cited by 36 publications

(26 citation statements)

References 18 publications

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“…Interestingly, current smokers had a decreased risk of hypoglycemia compared with nonsmokers in our study. These results differ from the findings of a recent study in type 1 diabetic subjects that reported a higher risk of hypoglycemia in smokers (23). Particularly for sulfonylurea users, the risk of developing hypoglycemia was substantially higher in the early phase of therapy.…”

Section: Hypoglycemiacontrasting

confidence: 57%

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

et al. 2008

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OBJECTIVE -Lactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEARCH DESIGN AND METHODS-This study is a nested case-control analysis using the U.K.-based General Practice Research Database to identify patients with type 2 diabetes who used oral antidiabetes drugs. Within the study population, all incident cases of lactic acidosis and hypoglycemia were identified, and hypoglycemia case subjects were matched to up to four control patients based on age, sex, practice, and calendar time.RESULTS -Among the study population of 50,048 type 2 diabetic subjects, six cases of lactic acidosis during current use of oral antidiabetes drugs were identified, yielding a crude incidence rate of 3.3 cases per 100,000 person-years among metformin users and 4.8 cases per 100,000 person-years among users of sulfonylureas. Relevant comorbidities known as risk factors for lactic acidosis could be identified in all case subjects. A total of 2,025 case subjects with hypoglycemia and 7,278 matched control subjects were identified. Use of sulfonylureas was associated with a materially elevated risk of hypoglycemia. The adjusted odds ratio for current use of sulfonylureas was 2.79 (95% CI 2.23-3.50) compared with current metformin use.CONCLUSIONS -Lactic acidosis during current use of oral antidiabetes drugs was very rare and was associated with concurrent comorbidity. Hypoglycemic episodes were substantially more common among sulfonylurea users than among users of metformin.

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Section: Hypoglycemiacontrasting

confidence: 57%

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

et al. 2008

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“…30 Collins also showed that smoking was independently associated with higher anxiety and depression scores in a cross-sectional study of 2049 individuals with type 1 or 2 diabetes in Ireland. 25 Besides the increased risk of developing macro- and some microvascular complications, 31 smokers with type 1 diabetes are more likely to have episodes of severe-hypoglycemia 32 and tend to engage in less health-related behaviors than former or never smokers, 33,34 increasing the chances of negative health effects of diabetes on their lives. In addition, pulmonary symptoms and signs may be related to depression.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Retinopathy Severity, Visual Impairment and Depression in Persons with Long-term Type 1 Diabetes

Hirai¹,

Tielsch²,

Klein³

et al. 2012

Ophthalmic Epidemiology

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Purpose Our aim was to investigate the proportion of individuals with depression and its association with diabetic retinopathy and visual impairment in a cohort with 25 or more years of type 1 diabetes. Methods This was a cross-sectional analysis at the 25-year follow-up of the population-based cohort of the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Examinations followed standardized protocols and included clinical and ophthalmic evaluations and questionnaires to assess current and past medical history, use of medications, and cigarette smoking. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to all participants. Depression was defined as use of antidepressant or CES-D score ≥16. Results A total of 484 individuals were included in the analysis. The proportion of depression was 37.8% (95% confidence interval 33.4–42.3%). A higher proportion of individuals with depression was observed among those with more severe diabetic retinopathy and visual impairment. However these associations were not statistically significant while controlling for other factors in the multivariable analyses. Conclusions Diabetic retinopathy severity and visual acuity in persons with long duration of type 1 diabetes were not cross-sectionally associated with depression in this cohort.

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“…In addition, some of the subjects were recruited from the local university which could increase education and income status in the control group. Even though the CACTI cohort has an overall lower rate of smoking than other large type 1 diabetes cohorts [23][24][25] and the Colorado and US averages, 26,27 the subjects were selected to limit confounding lifestyle factors for CAD by including spouses, friends and neighbours, and yet the subjects with type 1 diabetes smoke more than the non-diabetic subjects. Differences exist in lifestyle-related risk factors in men and women with type 1 diabetes compared with non-diabetic subjects in the CACTI study.…”

Section: Discussionmentioning

confidence: 99%

Lifestyle risk factors for atherosclerosis in adults with type 1 diabetes

Bishop

Maahs

Snell‐Bergeon

et al. 2009

Diabetes and Vascular Disease Research

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The objective of this study was to compare the amount of self-reported physical activity, alcohol and tobacco use in a large sample of adults with type 1 diabetes and non-diabetic subjects. A second aim is to test the hypothesis that these lifestyle risk factors are associated cross-sectionally with coronary artery calcification. In 2000-2002, the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study applied validated questionnaires for smoking, alcohol and physical activity to 582 type 1 diabetes subjects and 724 non-diabetic subjects. More type 1 diabetes subjects reported current smoking than non-diabetic subjects (12.3% versus 8.6%, p50.027). Overall, reported physical activity did not differ by diabetes status (p50.79). More type 1 diabetes subjects reported never having consumed alcohol (10% versus 4%, p<0.0001) and those who drank consumed less alcohol (p50.0015) than non-diabetic subjects. Physical activity and smoking were significantly associated with the presence of coronary artery calcification (adjusted OR50.9, 95% CI: 0.8-0.996, p50.045, and OR51.7, CI: 1.1-2.6, p50.03, respectively). Type 1 diabetes was independently associated with increased odds of coronary artery calcification (OR53.5, 95% CI: 2.5-5.0, p<0.0001). Differences exist in lifestyle-related cardiovascular risk factors in men and women with type 1 diabetes compared with non-diabetic subjects in the CACTI study.Keywords diabetes, cardiovascular disease, physical activity, smoking, alcohol factors in a large cohort of young adults with type 1 diabetes compared with non-diabetic subjects. A second aim is to test the hypothesis that these lifestyle factors are associated crosssectionally with coronary artery calcification (CAC), a marker of subclinical coronary artery atherosclerosis.

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Severe Hypoglycemia and Smoking in a Long-Term Type 1 Diabetic Population

Cited by 36 publications

References 18 publications

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

Relationship between Retinopathy Severity, Visual Impairment and Depression in Persons with Long-term Type 1 Diabetes

Lifestyle risk factors for atherosclerosis in adults with type 1 diabetes

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