scholarly journals Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

2020 ◽  
Author(s):  
Alexandra K. Lee ◽  
Stephen P. Juraschek ◽  
B. Gwen Windham ◽  
Clare J. Lee ◽  
A. Richey Sharrett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cohort Analysis ◽  
Severe Hypoglycemia ◽  
Emergency Department Visits ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Risk Of Falls ◽  
Aric Study

<b>Background</b>: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div><p><b>Methods</b>: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. </p> <p><b>Results</b>: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. </p> <p><b>Conclusions</b>: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes.</p> </div> <br>

scholarly journals Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

2020 ◽  
Author(s):  
Alexandra K. Lee ◽  
Stephen P. Juraschek ◽  
B. Gwen Windham ◽  
Clare J. Lee ◽  
A. Richey Sharrett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cohort Analysis ◽  
Severe Hypoglycemia ◽  
Emergency Department Visits ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Risk Of Falls ◽  
Aric Study

<b>Background</b>: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div><p><b>Methods</b>: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. </p> <p><b>Results</b>: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. </p> <p><b>Conclusions</b>: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes.</p> </div> <br>

367-P: Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 367-P
Author(s):  
ALEXANDRA K. LEE ◽  
STEPHEN P. JURASCHEK ◽  
B. GWEN WINDHAM ◽  
CLARE LEE ◽  
A. RICHEY SHARRETT ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Severe Hypoglycemia ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Risk Of Falls ◽  
Aric Study

scholarly journals Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Diabetes Care ◽  
2020 ◽  
Vol 43 (9) ◽  
pp. 2060-2065
Author(s):  
Alexandra K. Lee ◽  
Stephen P. Juraschek ◽  
B. Gwen Windham ◽  
Clare J. Lee ◽  
A. Richey Sharrett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Severe Hypoglycemia ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Risk Of Falls ◽  
Aric Study

scholarly journals Novel Risk Factors and the Prediction of Type 2 Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Diabetes Care ◽  
2012 ◽  
Vol 36 (1) ◽  
pp. 70-76 ◽  
Author(s):  
L. A. Raynor ◽  
J. S. Pankow ◽  
B. B. Duncan ◽  
M. I. Schmidt ◽  
R. C. Hoogeveen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Novel Risk Factors ◽  
Aric Study

scholarly journals Serum calcium and incident type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study

2016 ◽  
Vol 104 (4) ◽  
pp. 1023-1029 ◽  
Author(s):  
Mary R Rooney ◽  
James S Pankow ◽  
Shalamar D Sibley ◽  
Elizabeth Selvin ◽  
Jared P Reis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Serum Calcium ◽  
Atherosclerosis Risk In Communities ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Atherosclerosis Risk ◽  
Aric Study

Abstract MP76: Severe Hypoglycemia and Prevalence of Cognitive Impairment in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Alexandra K Lee ◽  
Andreea M Rawlings ◽  
Andrea L Schneider ◽  
A R Sharrett ◽  
Elbert S Huang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Severe Hypoglycemia ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Atherosclerosis Risk In Communities ◽  
Using Data ◽  
Diagnosed Diabetes ◽  
Aric Study

Introduction: Hypoglycemia and cognitive impairment are major problems in older adults with diabetes. It is unknown whether persons with prior hypoglycemia have distinct patterns of cognitive impairment compared to persons without hypoglycemia. Hypothesis: Compared to older adults with diabetes and no history of hypoglycemia, persons with prior hypoglycemia will have worse cognitive performance across all domains, but particularly in the executive function domain. Methods: We conducted a cross-sectional analysis of older adults with diagnosed diabetes using data from the ARIC study (2011-2013). Participants completed eight cognitive tests that measured three domains: memory, language, and executive function. Cognitive impairment in each domain was defined as having at least one test score lower than 1.5 standard deviations below age-, race-, and education-specific norms. We identified prior severe hypoglycemic events through 2012 with ICD-9 codes from hospitalizations and emergency department visits. We used Poisson regression with robust standard errors to generate prevalence ratios (PR) adjusted for demographic and clinical characteristics. Results: Among 1,867 adults with diagnosed diabetes: mean age 76 years, 56% female, 32% black, and 3% with prior hypoglycemia. In persons with prior hypoglycemia, 50% had cognitive impairment in at least one domain, compared to 43% in persons without prior hypoglycemia (p=0.24). After adjustment, persons with prior hypoglycemia were more likely to have worse performance in executive function (PR=1.73; 95% CI: 1.14-2.64) and language (PR=1.78; 95% CI: 1.08-2.93) but not memory (PR=1.19; 95% CI: 0.81-1.76) (Figure). Conclusions: Persons with prior severe hypoglycemia are a unique subset of older adults with diabetes with greater cognitive deficits in the domains of executive function and language. Their cognitive impairment presents challenges for the management of their diabetes and the prevention of additional hypoglycemic episodes and cognitive decline.

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