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

Yun, Jae‐Seung; Park, Young Jun; Han, Kyungdo; Kim, Hyung-Wook; Cha, Seon-Ah; Ahn, Yu‐Bae; Ko, Seung‐Hyun

doi:10.1038/s41598-021-82838-5

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…Our data suggest that, although patients may have a low BMI or do not smoke, they should require more medical attention for renal complications if they develop T2DM at an early age. Our data also suggest that patients with YOD who have concomitant hypertension or dyslipidemia should be aware of the potential development of nephropathy 30 .…”

Section: Discussionmentioning

confidence: 54%

Risk of developing chronic kidney disease in young-onset Type 2 diabetes in Korea: A nationwide population- based study

Lee

Yoon

et al. 2023

Preprint

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We investigated the risk of developing chronic kidney disease (CKD) in patients with young-onset Type 2 diabetes (YOD, diagnosed age <40 years). We enrolled 84,384 patients aged 20–64 who started anti-diabetic medication between 2010 and 2011 from the Korea National Health Insurance Sharing Service; patients with Type 1 diabetes or a history of CKD were excluded. Multivariate logistic regression analyses were performed to adjust for YOD-distinct variables and compare the incidence of CKD between YOD and late-onset diabetes (LOD, diagnosed age≥40 years). During the median observation period of 5.16 years (interquartile range: 4.58–5.77 years), 1,480 out of 77,039 LOD patients and 34 out of 7,345 YOD patients developed CKD. Patients with YOD had distinct baseline characteristics compared with the patients with LOD. The odds ratio of developing CKD in patients with YOD over LOD was 1.70 (95% CI: 1.15–2.51) after adjusting clinically distinct variables. The increased CKD odds in YOD compared with LOD was greater in the non-smoking group (OR: 2.03, 95% CI: 1.26–3.26) than in the smoking group (OR: 1.49, 95% CI: 0.74–2.98, p=0.0393 for interaction). Among YOD patients, hypertension (34.76% vs. 64.71%, p=0.0003), dyslipidemia (46.87% vs. 73.53%, p=0.0019), and sulfonylurea use (35.54% vs. 52.94%, p=0.0345) were associated with CKD development. YOD patients have a greater risk of developing CKD than LOD patients after adjusting clinically distinct variables.

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Section: Discussionmentioning

confidence: 54%

Risk of developing chronic kidney disease in young-onset Type 2 diabetes in Korea: A nationwide population- based study

Lee

Yoon

et al. 2023

Preprint

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“…Low blood glucose is known to be associated with increased mortality, CVD and ESRD in diabetes patients as well as the increased risk for the development of new-onset diabetes [ 30 ]. In a large nationwide T2DM cohort study, clinically significant hypoglycemia was associated with a 1.8 and 1.5-fold greater risk of developing incident CKD and all-cause mortality [ 31 , 32 ], and post hoc analysis of Action in Diabetes and Vascular disease: PreterAx and DiamicroN Controlled Evaluation (ADVANCE) study showed that hypoglycemia was associated with increased risks of micro- and macro-vascular events [ 33 ]. However, hypoglycemia has not been well studied in the general population without diabetes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with the discordance in kidney function decline rate in identical twins

et al. 2023

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Background The rate of kidney function decline is different for each individual regardless of any difference in the medical histories. This study set out to identify the risk factors for high discordance in kidney function decline in an identical twin cohort. Methods This study included 333 identical twins from the Korean Genome and Epidemiology Study who were categorized into two groups according to the estimated glomerular filtration rate (eGFR) decline: the slow and rapid progressor groups. The mean differences of variables were compared between the two groups. We calculated the difference in the annual eGFR change between twins and analyzed the risk factors associated with high discordance in twins who had > 5 mL/min/1.73 m2 /yr of the intra-twin difference in the annual eGFR decline. Identical twins with diabetes and baseline eGFR < 60 mL/min/1.73 m2 were excluded. Results The high discordance twins showed significant differences in body mass index; waist-to-hip ratio; total body fat percentage; and levels of blood hemoglobin, serum fasting glucose, albumin, triglyceride, and uric acid; however, there were no differences in low discordance twins. Multivariable logistic regression showed that blood hemoglobin level is the only significant factor associated with high discordance of eGFR decline in twins. Conclusions Blood hemoglobin level may play a role in the individual differences in kidney function decline.

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“…The primary outcome was newly diagnosed SH during the follow-up period. According to ICD-10 based diagnostic clinical codes for SH [ 17 – 20 ], postmenopausal women with T2DM who had any claims for E1163−, E1463–, E160–, E161–, and E162–from inpatient, outpatient, or emergency room since the date of the health examination were classified as having experienced SH episodes. Only the first SH episodes within the observation period were included.…”

Section: Methodsmentioning

confidence: 99%

Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus

et al. 2022

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Background: Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. Methods: This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. Results: During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30−34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35−39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. Conclusion: Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.

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

Cited by 13 publications

References 32 publications

Risk of developing chronic kidney disease in young-onset Type 2 diabetes in Korea: A nationwide population- based study

Risk of developing chronic kidney disease in young-onset Type 2 diabetes in Korea: A nationwide population- based study

Risk factors associated with the discordance in kidney function decline rate in identical twins

Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus

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