The DOI matches its Crossref record; 5 of the 5 references it cites were found in a registry or an index.
The Impact of Frequent and Unrecognized Hypoglycemia on Mortality in the ACCORD Study
Abstract
OBJECTIVE: The aim of this study was to examine the relationship between frequent and unrecognized hypoglycemia and mortality in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study cohort. RESEARCH DESIGN AND METHODS: A total of 10,096 ACCORD study participants with follow-up for both hypoglycemia and mortality were included. Hazard ratios (95% CIs) relating the risk of death to the updated annualized number of hypoglycemic episodes and the updated annualized number of intervals with unrecognized hypoglycemia were obtained using Cox proportional hazards regression models, allowing for these hypoglycemia variables as time-dependent covariates and controlling for the baseline covariates. RESULTS: Participants in the intensive group reported a mean of 1.06 hypoglycemic episodes (self-monitored blood glucose <70 mg/dL or <3.9 mmol/L) in the 7 days preceding their regular 4-month visit, whereas participants in the standard group reported an average of 0.29 episodes. Unrecognized hypoglycemia was reported, on average, at 5.8% of the intensive group 4-month visits and 2.6% of the standard group visits. Hazard ratios for mortality in models including frequency of hypoglycemic episodes were 0.93 (95% CI 0.9–0.97; P < 0.001) for participants in the intensive group and 0.98 (0.91–1.06; P = 0.615) for participants in the standard group. The hazard ratios for mortality in models, including unrecognized hypoglycemia, were not statistically significant for either group. CONCLUSIONS: Recognized and unrecognized hypoglycemia was more common in the intensive group than in the standard group. In the intensive group of the ACCORD study, a small but statistically significant inverse relationship of uncertain clinical importance was identified between the number of hypoglycemic episodes and the risk of death among participants.
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“exposure to hypoglycemia is associated with increased morbidity and mortality”
From Stress, hypoglycemia, and the autonomic nervous system (2022) · cites this paper as Seaquist et al., 2012
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Cites
Effects of Intensive Glucose Lowering in Type 2 Diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802743 · Cited by 7,888
Severe hypoglycemia and risks of vascular events and death
Zoungas, S., Patel, A., Chalmers, J., de Galan, B. E., Li, Q., Billot, L., Woodward, M., Ninomiya, T., Neal, B., MacMahon, S., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003795 · Cited by 1,471
Bonds, D. E., Miller, M. E., Bergenstal, R. M., Buse, J. B., Byington, R. P., Cutler, J. A., Dudl, R. J., Ismail-Beigi, F., Kimel, A. R., Hoogwerf, B., et al. (2010) · BMJ · doi:10.1136/bmj.b4909 · Cited by 933 · cited 3×
“This is in contrast to the positive relationship previously identified between mortality and episodes of severe hypoglycemia requiring medical assistance in both treatment groups (6).”
BackgroundResultInfluentialSelf-citationRiddle, M. C., Ambrosius, W. T., Brillon, D. J., Buse, J. B., Byington, R. P., Cohen, R. M., Goff, D. C., Malozowski, S., Margolis, K. L., Probstfield, J. L., et al. (2010) · Diabetes Care · doi:10.2337/dc09-1278 · Cited by 406
Self-citationHypoglycemia: The Limiting Factor in the Management of IDDM
Cryer, P. E. (1994) · Diabetes · doi:10.2337/diab.43.11.1378 · Cited by 307
Research works printed but not linked: 5
- Jones, 1997, Resistance to neuroglycopenia: an adaptive response during intensive insulin treatment of diabetes, J Clin Endocrinol Metab, 82, 1713
- Fanelli, 1998, Impact of nocturnal hypoglycemia on hypoglycemic cognitive dysfunction in type 1 diabetes, Diabetes, 47, 1920, 10.2337/diabetes.47.12.1920 · DOI
- Bonds, 2007, Severe hypoglycemia monitoring and risk management procedures in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Am J Cardiol, 99, 80i, 10.1016/j.amjcard.2007.03.026 · DOI
- International Organization for Standardization, 2003, In Vitro Diagnostic Test Systems: Requirements for Blood-Glucose Monitoring Systems for Self-Testing in Managing Diabetes Mellitus
- Sachs, 2011, Cognitive impairment: an independent predictor of excess mortality: a cohort study, Ann Intern Med, 155, 300, 10.7326/0003-4819-155-5-201109060-00007 · DOI
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Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia
Umpierrez, G., & Korytkowski, M. (2016) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2016.15 · Cited by 563
Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality
Orchard, T. J., Nathan, D. M., Zinman, B., Cleary, P., Brillon, D., Backlund, J.-Y. C., & Lachin, J. M. (2015) · JAMA · doi:10.1001/jama.2014.16107 · Cited by 437
Fox, C. S., Golden, S. H., Anderson, C., Bray, G. A., Burke, L. E., de Boer, I. H., Deedwania, P., Eckel, R. H., Ershow, A. G., Fradkin, J., et al. (2015) · Circulation · doi:10.1161/cir.0000000000000230 · Cited by 386
The importance of weight management in type 2 diabetes mellitus
Wilding, J. P. H. (2014) · International Journal of Clinical Practice · doi:10.1111/ijcp.12384 · Cited by 314
Bergenstal, R. M., Ahmann, A. J., Bailey, T., Beck, R. W., Bissen, J., Buckingham, B., Deeb, L., Dolin, R. H., Garg, S. K., Goland, R., et al. (2013) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2013.0051 · Cited by 307
Papademetriou, V., Lovato, L., Doumas, M., Nylen, E., Mottl, A., Cohen, R. M., Applegate, W. B., Puntakee, Z., Yale, J. F., & Cushman, W. C. (2015) · Kidney International · doi:10.1038/ki.2014.296 · Cited by 210
Mechanisms of hypoglycemia unawareness and implications in diabetic patients
Martín-Timón, I. (2015) · World Journal of Diabetes · doi:10.4239/wjd.v6.i7.912 · Cited by 204
Cariou, B., Fontaine, P., Eschwege, E., Lièvre, M., Gouet, D., Huet, D., Madani, S., Lavigne, S., & Charbonnel, B. (2015) · Diabetes & Metabolism · doi:10.1016/j.diabet.2014.10.007 · Cited by 129
Glucose targets for preventing diabetic kidney disease and its progression
Ruospo, M., Saglimbene, V. M., Palmer, S. C., De Cosmo, S., Pacilli, A., Lamacchia, O., Cignarelli, M., Fioretto, P., Vecchio, M., Craig, J. C., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010137.pub2 · Cited by 111
The ORIGIN Trial Investigators (2015) · Diabetes Care · doi:10.2337/dc14-1329 · Cited by 75
Lucidi, P., Porcellati, F., Bolli, G. B., & Fanelli, C. G. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1065-6 · Cited by 38
Stress, hypoglycemia, and the autonomic nervous system
Haas, A., Borsook, D., Adler, G., & Freeman, R. (2022) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.102983 · Cited by 30
Muneer, M. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/5584_2020_534 · Cited by 28
A New Role for Glucagon: From Secondary Hormone to Key Player
De Fano, M., Malara, M., Rucco, S., Manco, M., Fanelli, C. G., Bolli, G. B., & Porcellati, F. (2025) · Nutrition, Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2025.104233 · Cited by 1
Metadata
- Authors
- Seaquist, E. R., Miller, M. E., Bonds, D. E., Feinglos, M., Goff, D. C., Peterson, K., Senior, P., & for the ACCORD Investigators
- Affiliations
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Family Medicine, Minneapolis, Minnesota
- Department of Medicine, Division of Endocrinology, University of Alberta School of Medicine, Edmonton, Alberta, Canada
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2012-01-16
- Volume
- 35
- Issue
- 2
- Pages
- 409-414
- ISSN
- 0149-5992
- 1935-5548
- Cited by
- 131
- References
- 5
- Language
- en
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