Is autonomic neuropathy a risk factor for severe hypoglycaemia? The EURODIAB IDDM Complications Study |
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Authors: | J M Stephenson P Kempler P Cavallo Perin J H Fuller |
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Institution: | (1) Department of Epidemiology and Public Health, UCL Medical School, London, UK, GB;(2) First Department of Medicine, Semmelweis University, Budapest, Hungary, HU;(3) Clinica Medica Generale e Terapia Medica B, Ospedale San Giovanni Batista E Della, Turin, Italy, IT |
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Abstract: | Summary The hypothesis that diabetic patients with autonomic neuropathy are at increased risk of severe hypoglycaemia was examined
in an epidemiological study of over 3000 IDDM patients in Europe (EURODIAB IDDM Complications Study). Autonomic function was
assessed by two standard cardiovascular tests: change in heart rate and systolic blood pressure on standing. Severe hypoglycaemia
was defined as an attack serious enough to require the help of another person. Compared to patients (68 %) reporting no attacks
in the last year, those reporting one or more attacks were older (34.0 ± 10.7 vs 32.1 ± 9.9 years, mean ± SD, p < 0.0001), had had diabetes for a longer period (16.6 ± 9.5 vs 13.8 ± 9.1 years, p < 0.0001), had better glycaemic control (HbA1c 6.4 ± 1.8 vs 6.9 ± 1.9 %, p < 0.0001) and were more likely (p = 0.002) to have abnormal responses to both autonomic tests (13.0 vs 7.7 %). A single abnormal autonomic response was not
associated with an increased risk of severe hypoglycaemia. The odds ratio for severe hypoglycaemia in people with abnormal
responses to both autonomic tests, compared to those with normal responses, was 1.7 (95 % confidence interval 1.3, 2.2) after
controlling for age, duration of diabetes, glycaemic control and study centre. In conclusion, a combined autonomic deficit
in heart rate and blood pressure responses to standing is associated with only a modest increase in the risk of severe spontaneous
hypoglycaemia. Although the increase in risk is not large, severe hypoglycaemia was a frequently reported event in this study.
IDDM patients with deficient autonomic responses who strive for tight glycaemic control may therefore be at particular risk
of severe hypoglycaemia. Diabetologia (1996) 39: 1372–1376]
Received: 28 December 1995 and in final revised form: 11 June 1996 |
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Keywords: | Autonomic neuropathy severe hypoglycaemia glycaemic control insulin-dependent diabetes mellitus |
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