Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study

Kamlesh Khuntiet al. Diabetes Care. Doi: 10.2337/dc14-0920

This study also used CPRD to assess the risks of insulin treatment, this time focusing on the adverse outcome of hypoglycaemia. Hypoglycaemia is a hot topic in diabetes. Compared to older diabetes treatments (sulphonylureas and human insulins) recently launched antidiabetes therapies have a lower hypoglycaemia risk. Severe hypoglycaemia, requiring third-party intervention, is clearly important, however, it is relatively uncommon, especially in clinical trials. Quantifying the importance of mild hypoglycaemia is much more difficult, with agencies such as NICE attributing no financial cost to these episodes. This makes the case for using newer therapies tricky since they are inevitably more expensive. The authors report an increased hazard ratio for cardiovascular disease (CV) and all-cause mortality in subjects who experienced hypoglycaemia, both in type 1 and type 2 diabetes. This would imply a financial burden and this could contribute the economic justification for newer therapies. Once again, however, cause-and-effect cannot be proven; it could be that patients prone to hypoglycaemia are prone to CV events. This type of study can only be hypothesis-generating and prospective studies are needed.
http://care.diabetesjournals.org/content/early/2014/12/02/dc14-0920.abstract