What is it about?

We analyzed an at-baseline young and generally healthy type 1 diabetes cohort, the DCCT cohort, with no cardiovascular complications but mild to moderate microvascular complications, namely retinopathy. This cohort was followed for roughly 30 years. With our analysis, we show for the first time that the effect of severe hypoglycemia on ischemic heart disease (IHD) in a young type 1 diabetes cohort is modified by markers of baseline microvascular disease severity. With increasing baseline duration of diabetes, retinopathy severity level, or Diabetes Complication Severity Index (DCSI), the effect of severe hypoglycemia expressed by the hazard ratio for IHD based on severe hypoglycemia becomes stronger. We found that severe hypoglycemia was a significant ischemic heart disease factor for young type 1 diabetes patients who presented with longer diabetes duration, higher retinopathy severity levels, or higher DCSI levels.

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Why is it important?

Our analysis highlights the importance of treating both glycemic control and severe hypoglycemia as cardiovascular risk factors in diabetes and managing them accordingly. Just recently, although in type 2 diabetes, it has been emphasized that special attention should be directed toward severe hypoglycemia reduction in the older diabetes population with comorbidity. We now show for the first time that this special attention needs to include younger type 1 diabetes individuals with microvascular disease, namely retinopathy, to reduce ischemic heart disease risk.


Our findings are exciting. We believe our findings are thought provoking and contribute to a better understanding of the complicated nature of the severe hypoglycemia role in cardiovascular disease. We are convinced that this better understanding leads to more effective diabetes management.

Elke Fahrmann
Marshall University, Joan C Edwards, School of Medicine

Read the Original

This page is a summary of: Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study, Diabetes Care, July 2021, American Diabetes Association,
DOI: 10.2337/dc20-2757.
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