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  • March 20, 2019
  • Zhong, Wenze
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
  • Hypoglycemia (blood glucose <70 mg/dL) is a major barrier for achieving normoglycemia in diabetes. Three critical gaps are: i) limited data exist on describing longitudinal incidence of severe hypoglycemia both in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D); ii) the relationship of HbA1c level with risk of severe hypoglycemia in patients with T1D or T2D remains controversial; iii) how usual dietary intake impacts on risk of hypoglycemia in patients with T1D is unclear. To address first two gaps, we used primary and secondary care data from the Clinical Practice Research Datalink and Hospital Episode Statistics in England. Temporal trends of hypoglycemia requiring hospitalization in adults with T1D (N=23,251) or T2D (N=241,829) from 1998 to 2013 were estimated using joinpoint regression model. By analyzing 1:6 case-control matched dataset using conditional logistic regression models, we investigated the association between HbA1c level and risk of hypoglycemia hospitalization in adults with incident T1D (N=5,776) or T2D (N=163,237). To address the third gap, we applied logistic regression models to identify dietary predictors of non-severe hypoglycemia in 98 T1D adolescents who wore continuous glucose monitor for one week and had two days of 24-hour dietary recalls. Between 1998 and 2013 in England, the incidence of hypoglycemia hospitalizations increased both in adults with T1D and T2D. In adults with T1D, compared to HbA1c 7-7.9%, higher HbA1c level was associated with lower risk of hypoglycemia hospitalization while lower HbA1c level did not increase the risk. In adults with T2D, both lower and higher HbA1c level increased hypoglycemia hospitalization risk (i.e., U-shape). In adolescents with T1D, lower risk of daytime non-severe hypoglycemia was related to higher glycemic index of the diet or higher intake of monounsaturated or polyunsaturated fat. Higher intake of soluble fiber or protein was associated with higher risk of daytime and nocturnal non-severe hypoglycemia. Adjusting for insulin dose per kilogram eliminated all these associations. Practical approaches for hypoglycemia management are urgently needed to reduce the fast growing hypoglycemia burden in England. Applying appropriate HbA1c treatment targets and appropriately matching insulin dose and injection time to freely consumed meals may reduce hypoglycemia risk.
Date of publication
Resource type
Rights statement
  • In Copyright
  • Juhaeri, Juhaeri
  • Gordon-Larsen, Penny
  • Cole, Stephen
  • Shay, Christina
  • Mayer-Davis, Elizabeth
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016

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