Diabetes & Metabolism Journal

Original Articles

Complications
Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes: Jae-Seung Yun, Seung-Hyun Ko, Sun-Hye Ko, Ki-Ho Song, Ki-Dong Yoo, Kun-Ho Yoon, Yong-Moon Park, Yu-Bae Ahn; Diabetes Metab J. 2015;39(6):498-506. Published online July 8, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.6.498

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Background

To investigate whether a history of prior cardiovascular disease (CVD) is associated with severe hypoglycemia (SH) in patients with type 2 diabetes.

Methods

We conducted a prospective cohort study from January 2001 to December 2012 with a median follow-up time of 9.5 years (5,814 person-years). Patients aged 25 to 75 years with type 2 diabetes and without chronic kidney disease were enrolled (n=894), and 624 patients completed follow-up. SH was defined as hypoglycemic episodes requiring hospitalization or medical care in an emergency department. We used the Cox proportional hazards regression analysis to test associations between SH episodes and potential explanatory variables.

Results

Among the 624 participants who completed follow-up, 60 patients (9.6%) had previous CVD. Compared to patients without CVD, patients with previous CVD were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline. During follow-up, 62 patients (9.9%) experienced at least one SH episode (incidence of 1.33 per 100 patient-years). The development of SH was associated with a history of CVD (hazard ratio, 1.99; 95% confidence interval, 1.07 to 3.72; P=0.031) after adjusting for sex, age, diabetic duration, hypertension, hemoglobin A1c levels, diabetic complications, cardiovascular autonomic neuropathy, and insulin use.

Conclusion

A history of CVD was an independent risk factor for the development of SH in patients with type 2 diabetes mellitus. For patients with CVD, modulation of glycemic targets and diabetic education for the prevention of hypoglycemia should be implemented.

Citations

Citations to this article as recorded by

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Concomitant Use of Sulfonylureas and β-Blockers and the Risk of Severe Hypoglycemia Among Patients With Type 2 Diabetes: A Population-Based Cohort Study
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Jae-Seung Yun
The Journal of Korean Diabetes.2022; 23(4): 245. CrossRef
Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention
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Jeffrey Freeman
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Coronary artery disease severity modifies associations between glycemic control and both mortality and myocardial infarction
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Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients
Eun-Gyo Jeong, Sung Shim Cho, Sang-Hoon Lee, Kang-Min Lee, Seo-Kyung Woo, Yoongoo Kang, Jae-Seung Yun, Seon-Ah Cha, Yoon-Jung Kim, Yu-Bae Ahn, Seung-Hyun Ko, Jung-Min Lee
The Korean Journal of Internal Medicine.2018; 33(5): 952. CrossRef
Time- and frequency-domain measures of heart rate variability predict cardiovascular outcome in patients with type 2 diabetes
Seon-Ah Cha, Yong-Moon Park, Jae-Seung Yun, Seung-Hwan Lee, Yu-Bae Ahn, Sung-Rae Kim, Seung-Hyun Ko
Diabetes Research and Clinical Practice.2018; 143: 159. CrossRef
Risk Factors for Severe Hypoglycemia in Black and White Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Alexandra K. Lee, Clare J. Lee, Elbert S. Huang, A. Richey Sharrett, Josef Coresh, Elizabeth Selvin
Diabetes Care.2017; 40(12): 1661. CrossRef
Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes
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Cardiovascular Autonomic Dysfunction Predicts Diabetic Foot Ulcers in Patients With Type 2 Diabetes Without Diabetic Polyneuropathy
Jae-Seung Yun, Seon-Ah Cha, Tae-Seok Lim, Eun-Young Lee, Ki-Ho Song, Yu-Bae Ahn, Ki-Dong Yoo, Joon-Sung Kim, Yong-Moon Park, Seung-Hyun Ko
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Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes
Seon-Ah Cha, Jae-Seung Yun, Tae-Seok Lim, Kyoungil Min, Ki-Ho Song, Ki-Dong Yoo, Yong-Moon Park, Yu-Bae Ahn, Seung-Hyun Ko, James M Wright
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Meta-analysis: Association between hypoglycaemia and serious adverse events in older patients
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Letter: Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes (Diabetes Metab J 2015;39:498-506)
Mi-Kyung Kim
Diabetes & Metabolism Journal.2016; 40(1): 83. CrossRef
Response: Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes (Diabetes Metab J 2015;39:498-506)
Jae-Seung Yun, Yu-Bae Ahn
Diabetes & Metabolism Journal.2016; 40(1): 85. CrossRef
Lipoprotein(a) predicts a new onset of chronic kidney disease in people with Type 2 diabetes mellitus
J.‐S. Yun, Y.‐B. Ahn, K.‐H. Song, K.‐D. Yoo, Y.‐M. Park, H.‐W. Kim, S.‐H. Ko
Diabetic Medicine.2016; 33(5): 639. CrossRef
Severe Hypoglycemia and Cardiovascular Disease in Type 2 Diabetes
Hyeong Kyu Park
Diabetes & Metabolism Journal.2015; 39(6): 478. CrossRef

Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes: Yun-Mi Yong, Kyung-Mi Shin, Kang-Min Lee, Jae-Young Cho, Sun-Hye Ko, Min-Hyang Yoon, Tae-Won Kim, Jong-Hyun Jeong, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn; Diabetes Metab J. 2015;39(2):154-163. Published online March 10, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.2.154

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Abstract PDF Supplementary Material PubReader

Background

We investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes.

Methods

From March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT) were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24]) attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia.

Results

The total study population consisted of 20 men (43.5%; mean age and diabetic duration of 55.9±11.0 and 5.1±7.3 years, respectively). At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was 5.26±6.5 in the CG and 2.58±2.3 times in the IT (P=0.004). Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG.

Conclusion

Compared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

Citations

Citations to this article as recorded by

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Editorial

Internet-Based Mentoring Program for Patients with Type 1 Diabetes: Sun-Hye Ko, Seung-Hyun Ko; Diabetes Metab J. 2014;38(2):107-108. Published online April 18, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.2.107

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Original Article

Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program: Seung-Hyun Ko, Sin-Ae Park, Jae-Hyoung Cho, Sun-Hye Ko, Kyung-Mi Shin, Seung-Hwan Lee, Ki-Ho Song, Yong-Moon Park, Yu-Bae Ahn; Diabetes Metab J. 2012;36(3):222-229. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.222

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Abstract PDF PubReader

Background

Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.

Methods

Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (≤1 year [≤1Y] vs. ≥3 years [≥3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.

Results

The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the ≤1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the ≤1Y group than in the ≥3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).

Conclusion

Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

Citations

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Letter

Letter: Diabetic Polyneuropathy and Cardiovascular Complications in Type 2 Diabetic Patients (Diabetes Metab J 2011;35:390-6): Sun-Hye Ko, Seung-Hyun Ko; Diabetes Metab J. 2011;35(5):558-560. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.558

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Citations

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Rosiglitazone Increases CerebralKlothoExpression to Reverse Baroreflex in Type 1-Like Diabetic Rats
Li-Jen Chen, Meng-Fu Cheng, Po-Ming Ku, Jia-Wei Lin
BioMed Research International.2014; 2014: 1. CrossRef

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