A Link Between Hypoglycemia and Progression of Atherosclerosis in the Veterans Affairs Diabetes Trial (VADT)

作者：Saremi Aramesh; Bahn Gideon D; Reaven Peter D

来源：Diabetes Care, 2016, 39(3): 448-454.

DOI：10.2337/dc15-2107

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<jats:title>OBJECTIVE</jats:title>
<jats:p>To determine whether a link exists between serious hypoglycemia and progression of atherosclerosis in a substudy of the Veterans Affairs Diabetes Trial (VADT) and to examine whether glycemic control during the VADT modified the association between serious hypoglycemia and coronary artery calcium (CAC) progression.</jats:p>
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<jats:title>RESEARCH DESIGN AND METHODS</jats:title>
<jats:p>Serious hypoglycemia was defined as severe episodes with loss of consciousness or requiring assistance or documented glucose &amp;lt;50 mg/dL. Progression of CAC was determined in 197 participants with baseline and follow-up computed tomography scans.</jats:p>
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<jats:title>RESULTS</jats:title>
<jats:p>During an average follow-up of 4.5 years between scans, 97 participants reported severe hypoglycemia (n = 23) or glucose &amp;lt;50 mg/dL (n = 74). Serious hypoglycemia occurred more frequently in the intensive therapy group than in the standard treatment group (74% vs. 21%, P &amp;lt; 0.01). Serious hypoglycemia was not associated with progression of CAC in the entire cohort, but the interaction between serious hypoglycemia and treatment was significant (P &amp;lt; 0.01). Participants with serious hypoglycemia in the standard therapy group, but not in the intensive therapy group, had ∼50% greater progression of CAC than those without serious hypoglycemia (median 11.15 vs. 5.4 mm3, P = 0.02). Adjustment for all baseline differences, including CAC, or time-varying risk factors during the trial, did not change the results. Examining the effect of serious hypoglycemia by on-trial HbA1c levels (cutoff 7.5%) yielded similar results. In addition, a dose-response relationship was found between serious hypoglycemia and CAC progression in the standard therapy group only.</jats:p>
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<jats:title>CONCLUSIONS</jats:title>
<jats:p>Despite a higher frequency of serious hypoglycemia in the intensive therapy group, serious hypoglycemia was associated with progression of CAC in only the standard therapy group.</jats:p>
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• 出版日期2016-3