TY - JOUR
T1 - The relation between HbA1c and hypoglycemia revisited; a secondary analysis from an intervention trial in patients with type 1 diabetes and impaired awareness of hypoglycemia
AU - van Beers, Cornelis A.J.
AU - Caris, Martine G.
AU - DeVries, J. Hans
AU - Serné, Erik H.
PY - 2018/1
Y1 - 2018/1
N2 - Aims: We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia. Methods: 52 Patients with T1D and IAH participated in an earlier reported randomized, crossover trial with two 16-week intervention periods comparing continuous glucose monitoring (CGM) with self-monitoring of blood glucose (SMBG). In this previous study, time spent in normoglycemia (the primary outcome), was improved by 9.6% (p <. 0.0001). We performed post-hoc analyses using a zero-inflated Poisson regression model to assess the relationship between severe hypoglycemia and HbA1c, glucose variability and duration of diabetes. Results: During SMBG use, HbA1c and the number of severe hypoglycemic events were negatively associated (OR 0.20 [95% CI 0.09 to 0.44]). During CGM use, this relationship showed an odds ratio of 0.65 (95% CI 0.42 to 1.01). There was no significant relationship between glucose variability or duration of diabetes and severe hypoglycemia. Conclusions: In patients with T1D and IAH, treated with standard SMBG, a negative association exists between HbA1c and the number of severe hypoglycemic events. Thus, reaching target HbA1c values still comes with a higher risk of severe hypoglycemia. CGM weakens this association, suggesting CGM enables patients to reach their target HbA1c more safely.
AB - Aims: We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia. Methods: 52 Patients with T1D and IAH participated in an earlier reported randomized, crossover trial with two 16-week intervention periods comparing continuous glucose monitoring (CGM) with self-monitoring of blood glucose (SMBG). In this previous study, time spent in normoglycemia (the primary outcome), was improved by 9.6% (p <. 0.0001). We performed post-hoc analyses using a zero-inflated Poisson regression model to assess the relationship between severe hypoglycemia and HbA1c, glucose variability and duration of diabetes. Results: During SMBG use, HbA1c and the number of severe hypoglycemic events were negatively associated (OR 0.20 [95% CI 0.09 to 0.44]). During CGM use, this relationship showed an odds ratio of 0.65 (95% CI 0.42 to 1.01). There was no significant relationship between glucose variability or duration of diabetes and severe hypoglycemia. Conclusions: In patients with T1D and IAH, treated with standard SMBG, a negative association exists between HbA1c and the number of severe hypoglycemic events. Thus, reaching target HbA1c values still comes with a higher risk of severe hypoglycemia. CGM weakens this association, suggesting CGM enables patients to reach their target HbA1c more safely.
KW - HbA1c
KW - Hypoglycemia
KW - Impaired awareness of hypoglycemia
KW - Severe hypoglycemia
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85031680287&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jdiacomp.2017.09.005
DO - https://doi.org/10.1016/j.jdiacomp.2017.09.005
M3 - Article
C2 - 29054335
SN - 1056-8727
VL - 32
SP - 100
EP - 103
JO - Journal of diabetes and its complications
JF - Journal of diabetes and its complications
IS - 1
ER -