The relation between HbA1c and hypoglycemia revisited; a secondary analysis from an intervention trial in patients with type 1 diabetes and impaired awareness of hypoglycemia
Abstract
Aims We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia. Methods 52 Patients with T1D and IAH participated in an earlier reported randomized, crossover trial with two 16-week intervention periods comparing continuous glucose monitoring (CGM) with self-monitoring of blood glucose (SMBG). In this previous study, time spent in normoglycemia (the primary outcome), was improved by 9.6% (p Results During SMBG use, HbA1c and the number of severe hypoglycemic events were negatively associated (OR 0.20 [95% CI 0.09 to 0.44]). During CGM use, this relationship showed an odds ratio of 0.65 (95% CI 0.42 to 1.01). There was no significant relationship between glucose variability or duration of diabetes and severe hypoglycemia. Conclusions In patients with T1D and IAH, treated with standard SMBG, a negative association exists between HbA1c and the number of severe hypoglycemic events. Thus, reaching target HbA1c values still comes with a higher risk of severe hypoglycemia. CGM weakens this association, suggesting CGM enables patients to reach their target HbA1c more safely.
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A secondary analysis of the IN CONTROL trial demonstrated an increase in the rate of level 3 hypoglycemia with lower HbA1c.
“A secondary analysis of the IN CONTROL trial, where the primary analysis showed a reduction in level 3 hypoglycemia in people using CGM, demonstrated an increase in the rate of level 3 hypoglycemia with lower HbA 1c , similar to what was reported in the DCCT (106).”
Cites
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Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes.
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Hypoglycemia in the Diabetes Control and Complications Trial
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Diverse causes of hypoglycemia-associated autonomic failure in diabetes.
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Holt, R. I. G., DeVries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., et al. (2021) · Diabetes Care · doi:10.2337/dci21-0043 · Cited by 699 · see citing works
Self-citation
- Authors
- van Beers, C. A. J., Caris, M. G., DeVries, J. H., & Serné, E. H.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 32
- Issue
- 1
- Pages
- 100-103
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- OpenAlex
- W2753983651
- Cited by
- 11
- References
- 5
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 2
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- Eli Lilly and Company
- Sanofi
- Roche Diabetes Care
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- HbA1c, severe hypoglycemia, type 1 diabetes, impaired awareness of hypoglycemia, continuous glucose monitoring, self-monitoring of blood glucose, glycemic variability, glycemic control, diabetes duration
- MeSH terms
- Adult, Awareness, Blood Glucose, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Retrospective Studies, Blood Glucose Self-Monitoring, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Cross-Over Studies
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