Comment on Fahrmann et al. Modification of the Association Between Severe Hypoglycemia and Ischemic Heart Disease by Surrogates of Vascular Damage Severity in Type 1 Diabetes During ∼30 Years of Follow-up in the DCCT/EDIC Study. Diabetes Care 2021;44;2132–2139

Fahrmann et al. (1) reported that, in the 1,441 subjects with type 1 diabetes (T1D) included in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study cohort (none of whom had previous cardiovascular events), the presence of at least one event of severe hypoglycemia (SH) increased the risk of ischemic heart disease (IHD) (death, silent/nonfatal myocardial infarction, revascularization, and confirmed angina) in those patients with higher baseline surrogates of microvascular damage (diabetes duration or steps on the DCCT Early Treatment Diabetic Retinopathy Study severity scale and Diabetes Complication Severity Index) during a roughly 30-year follow-up period. Their analyses did not take into account the potential role of baseline insulin resistance (IR) as a predictor of IHD events. However, when IR was assessed through the equation for the estimation of the glucose disposal rate (the lower the estimated glucose disposal rate, the higher the IR) in the DCCT cohort, it was found to be an independent predictor of the development of retinopathy, nephropathy, and cardiovascular events (angina, fatal and nonfatal myocardial infarction, coronary revascularization, and major electrocardiographic events) over a 9-year follow-up period, introducing the concept of double diabetes with potential interest for a better phenotyping of patients with T1D in routine clinical practice (2). That equation includes only three clin...
Source: Diabetes Care - Category: Endocrinology Source Type: research