- Hypoglycemia risk should be considered when setting glycemic targets in type 2 diabetes (T2D).
Why this matters
- Role of severe hypoglycemic episodes (SHEs) in cardiovascular (CV) events is unclear.
- Post hoc analysis from Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) involving 14,671 patients with T2D and CV disease followed for a median of 3 years.
- Funding: Merck & Co., Inc., Kenilworth, NJ, USA.
- SHEs (ie, requiring assistance) did not differ between sitagliptin and placebo (2.2% vs 1.9%, respectively; HR, 1.12; P=.33).
- Patients with SHEs were older, had longer diabetes duration, lower weight, more impaired kidney function, and were more frequently nonwhite, female, and insulin-treated.
- Of 303 with SHEs, 22.4% had a major CV event or hospitalization for heart failure (hHF).
- Of those 68, SHE preceded event in 34, followed event in 38, and did both in 7.
- After adjustments, associations between SHEs and subsequent CV events lost significance.
- However, associations between nonfatal CV events and subsequent SHEs remained significant after adjustments, including CV event or unstable angina hospitalization (adjusted HR [aHR], 1.96; P=.001), myocardial infarction (2.31; P=.001), stroke (2.07; P=.046), hHF (2.26; P=.005).
- Post hoc evaluation.
- Low SHE rates.
- Possible confounding from therapy changes after events.