Proximal HbA1c level and first hypoglycaemia hospitalisation: what’s the link?

  • Zhong VW & al.
  • J Clin Endocrinol Metab
  • 3 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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 Takeaway

  • Adults with type 2 diabetes mellitus (T2DM) who have poor or near-normal glycaemic control are at increased risk for first hypoglycaemia hospitalisation (HH) in the following 3 months.

Why this matters

  • Previous studies reported inverse association, U-shaped association or that the previous strong inverse association between HbA1c level and severe hypoglycaemia was diminished with time. However, no previous study utilised HbA1c measurements around the time of hypoglycemia diagnosis, which may be more predictive of hypoglycaemia.

Study design

  • This nested case-control study used data from the Clinical Practice Research datalink and Hospital Episodes Statistics from the United Kingdom to evaluate the association between proximal HbA1c level (measured within 90 days prior to first hypoglycaemia requiring hospitalisation) and the risk for first HH in adults with incident T2DM.
  • Funding: Supported by the Sanofi Global Nutrition Scholars programme.

Key results

  • Compared with proximal HbA1c level of 7.0% (53 mmol/mol), the association was similar between proximal HbA1c level of 6.0% (42 mmol/mol; OR, 1.54; 95% CI, 1.12-2.11) and 9.0% (75 mmol/mol; OR, 1.48; 95% CI, 1.01-2.17).
  • For proximal HbA1c level of 4.0-6.5%, the risk of developing first HH was lower with every additional 0.5% increase in HbA1c with OR ranging between 0.37 (95% CI, 0.20-0.67) and 0.86 (95% CI, 0.76-0.98).
  • For proximal HbA1c level of 8.0-11.5%, every additional 0.5% increase in HbA1c was associated with higher odds of developing first HH risk with OR ranging between 1.16 (95% CI, 1.04-1.29) and 1.34 (95% CI, 1.18-1.52).
  • Among current sulfonylureas users, U-shaped association between proximal HbA1c level and first HH did not exist but persisted among current insulin users (P interaction=.002).

Limitations

  • Possibility of misclassification of diabetes.