Cardiac autonomic neuropathy modified the association between obesity and hypoglycemia in type 2 diabetes.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Pub Date : 2024-09-01 Epub Date: 2024-06-21 DOI:10.1007/s12020-024-03728-0

Wenjing Zhang, Yiquan Huang, Ziwei Zhou, Peihan Xie, Xiaodong Zhuang, Jingzhou Jiang, Xinxue Liao

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Abstract

Background: Previous studies have shown that increasing body mass index (BMI) was associated with decreased hypoglycemia in type 2 diabetes, but it remains uncertain whether this finding could be applied to patients with and without cardiac autonomic neuropathy (CAN).

Methods: The study included 7789 participants with type 2 diabetes from action to control cardiovascular risk in diabetes (ACCORD) trail. CAN was defined as SDNN < 8.2 ms and RMSSD < 8.0 ms. Obesity was defined as BMI ≥ 30 kg/m². Outcomes were identified as severe hypoglycemia requiring any assistance (HAA) or requiring medical assistance (HMA). We assessed the association between obesity and severe hypoglycemia in type 2 diabetes with or without CAN using COX regression models adjusted for baseline characteristics.

Results: Over a median follow-up of 4.7 years, a total of 893 participants developed HAA and 584 participants developed HMA. Compared with non-obesity, obesity was associated with lower risk of severe hypoglycemia (HAA: hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.38-0.68, P < 0.001; HMA: HR 0.57, 95% CI 0.40-0.82, P = 0.002) in CAN present group, but not in CAN absent group (HAA: HR 0.98, 95% CI 0.83-1.16, P = 0.830; HMA: HR 0.97, 95% CI 0.79-1.19, P = 0.754). Similarly, increasing BMI was associated with reduced severe hypoglycemic events in participants with CAN, but not in participants without CAN.

Conclusions: CAN modifies the association between obesity and hypoglycemia in type 2 diabetes. Type 2 diabetic individuals with CAN who are under weight control should pay attention to hypoglycemic events.

Trial registry: http://www.

Clinicaltrials: gov . Unique identifier: NCT00000620.

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心脏自主神经病变改变了 2 型糖尿病患者肥胖与低血糖之间的关联。

背景：先前的研究表明，体重指数（BMI）的增加与 2 型糖尿病患者低血糖症的减少有关，但仍不确定这一发现是否适用于有或没有心脏自主神经病变（CAN）的患者：该研究纳入了7789名2型糖尿病患者，他们均来自 "控制糖尿病心血管风险行动（ACCORD）"项目。CAN 被定义为 SDNN 2。结果被确定为需要任何协助（HAA）或需要医疗协助（HMA）的严重低血糖。我们使用根据基线特征调整的 COX 回归模型评估了有或无 CAN 的 2 型糖尿病患者肥胖与严重低血糖之间的关系：在中位随访 4.7 年期间，共有 893 名参与者出现 HAA，584 名参与者出现 HMA。与非肥胖者相比，肥胖者发生严重低血糖的风险较低（HAA：危险比[HR]0.51，95% 置信区间[CI]0.38-0.68，P 结论：CAN改变了2型糖尿病患者肥胖与低血糖之间的关系。患有 CAN 并控制体重的 2 型糖尿病患者应注意低血糖事件。试验登记：http://www.Clinicaltrials: gov 。唯一标识符：NCT00000620.

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.