History of Severe Hypoglycemia in Type II Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A Matched Case-control Study
Mohd Asyiq Al-Fard bin Mohd Raffali1, Shawal Faizal Mohamad1, Patrick WJ Tiau1, Diyana Farouk1, Hamat Hamdi Che Hassan1
Pusat Perubatan Universiti Kebangsaan Malaysia, Malaysia1
History of severe hypoglycemia (SH) has been associated with cardiovascular (CV) events among patients with type II diabetes mellitus (T2DM) based on retrospective analysis of a few prospective studies. In this study, we screened patients with glucometer proven history of SH for established atherosclerotic coronary artery disease (ACAD).
We conducted a matched case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD and crossed matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) followed by CT coronary angiography (CCTA) if indicated to evaluate the severity of their ACAD.
History of SH in T2DM was associated with 79% (22 out of 28) incidence of significant ACAD compared to 46% (13 out of 28) in those without history of SH, based on either CACS ≥ 400, and/or presence of at least one major coronary artery with ≥ 50% stenosis from CCTA, (p = 0.026). Greater number of patients with history of SH had CACS ≥ 100, 75% (21 out of 28) compared to those without history of SH, 43% (12 out of 28) (p= 0.029). Similarly, those with SH had higher incidence of obstructive CAD, 72% (13 out of 18) compared to 39% (10 out of 26) in those without history of SH (p= 0.036). Median C-reactive protein level was also higher among patients with history of SH, 0.41mg/dL as compared to those without history of SH, 0.16 mg/dL, (p = 0.029).
History of SH in T2DM is significantly associated with ACAD compared to T2DM without any history of SH. This is also reflected by higher hs-CRP level in those with history of SH. Our finding recommends that history of SH in T2DM warrants prompt screening for established ACAD.