Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

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Features of partial remission in children with type 1 diabetes using the insulin dose-adjusted A1c definition and risk factors associated with nonremission

Annals of Pediatric Endocrinology & Metabolism ◽

10.6065/apem.2040202.101 ◽

2021 ◽

Vol 26 (2) ◽

pp. 118-125

Author(s):

Tsz Wai Catherine Wong ◽

Man Yee Shirley Wong ◽

Wai Man Betty But

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Partial Remission ◽

Insulin Dose ◽

Factors Associated

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Risk factors associated with the development of retinopathy 10 yr after the diagnosis of juvenile-onset type 1 diabetes in Taiwan: a cohort study from the CGJDES

Pediatric Diabetes ◽

10.1111/pedi.12312 ◽

2015 ◽

Vol 17 (6) ◽

pp. 407-416 ◽

Cited By ~ 9

Author(s):

Nan-Kai Wang ◽

Chi-Chun Lai ◽

Jung-Pan Wang ◽

Wei-Chi Wu ◽

Laura Liu ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cohort Study ◽

Juvenile Onset ◽

Factors Associated ◽

Onset Type

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Risk Factors Associated with Depressive Symptoms in Caregivers of Children with Type 1 Diabetes or Cystic Fibrosis

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsp138 ◽

2010 ◽

Vol 35 (8) ◽

pp. 814-822 ◽

Cited By ~ 33

Author(s):

K. A. Driscoll ◽

S. B. Johnson ◽

D. Barker ◽

A. L. Quittner ◽

L. C. Deeb ◽

...

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Type 1 Diabetes ◽

Depressive Symptoms ◽

Factors Associated

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Early childhood risk factors associated with type 1 diabetes – is gender important?

European Journal of Epidemiology ◽

10.1007/s10654-005-0878-1 ◽

2005 ◽

Vol 20 (5) ◽

pp. 429-434 ◽

Cited By ~ 50

Author(s):

Jannet Svensson ◽

Bendix Carstensen ◽

Henrik B. Mortensen ◽

Knut Borch-Johnsen ◽

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Early Childhood ◽

Factors Associated ◽

Childhood Risk Factors

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Risk Factors Associated With Corneal Nerve Alteration in Type 1 Diabetes in the Absence of Neuropathy

Cornea ◽

10.1097/ico.0000000000000760 ◽

2016 ◽

Vol 35 (6) ◽

pp. 847-852 ◽

Cited By ~ 15

Author(s):

Cirous Dehghani ◽

Nicola Pritchard ◽

Katie Edwards ◽

Anthony W. Russell ◽

Rayaz A. Malik ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Factors Associated ◽

Corneal Nerve

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Risk Factors Associated With the Development of Nephropathy 10 Years After Diagnosis in Taiwanese Children With Juvenile-Onset Type 1 Diabetes—A Cohort Study From the CGJDES

Frontiers in Endocrinology ◽

10.3389/fendo.2018.00429 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 2

Author(s):

Ching-Chien Yang ◽

Chia-Hung Lin ◽

Nan-Kai Wang ◽

Chi-Chun Lai ◽

Fu-Sung Lo ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Cohort Study ◽

Juvenile Onset ◽

Factors Associated ◽

Onset Type

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Association of Type 1 Diabetes and Hypoglycemic and Hyperglycemic Events and Risk of Dementia

Neurology ◽

10.1212/wnl.0000000000012243 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012243

Author(s):

Rachel A. Whitmer ◽

Paola Gilsanz ◽

Charles P. Quesenberry ◽

Andrew J. Karter ◽

Mary E. Lacy

Keyword(s):

Older Adults ◽

Type 1 Diabetes ◽

Healthcare Delivery ◽

Severe Hypoglycemia ◽

Older Individuals ◽

Healthcare Delivery System ◽

Dementia Risk ◽

History Of ◽

Cox Proportional Hazard Models

Objective:To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes.Methods:A longitudinal cohort study followed 2,821 members of an integrated healthcare delivery system with type 1 diabetes from 1997-2015. Hypoglycemic and hyperglycemic events requiring emergency room or hospitalization were abstracted from medical records beginning 1/1/1996 through cohort entry. Participants were followed for dementia diagnosis through 9/30/2015. Dementia risk was examined using Cox proportional hazard models adjusted for age (as timescale), sex, race/ethnicity, HbA1c, depression, stroke, and nephropathy.Results:Among 2,821 older adults (mean age 56) with type 1 diabetes, 398 (14%) had a history of severe hypoglycemia, 335 (12%) severe hyperglycemia and 87 (3%) both. Over a mean 6.9 years of follow-up, 153 individuals (5.4%) developed dementia. In fully adjusted models, individuals with hypoglycemic events had 66% greater risk of dementia than those without a hypoglycemic event (HR=1.66; 95% CI: 1.09, 2.53), while those with hyperglycemic events had >2 times the risk (HR=2.11; 95% CI: 1.24, 3.59) than those without a hyperglycemic event. There was a 6-fold greater risk of dementia in individuals with both severe hypoglycemia and hyperglycemia versus those with neither (HR=6.20; 95% CI: 3.02, 12.70).Conclusions:For older individuals with type 1 diabetes, severe hypoglycemic and hyperglycemic events are associated with increased future risk of dementia.

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