Abstract P048: Risk Factors for Severe Hypoglycemia Differ in Black and White Older Adults With Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study
Introduction: Blacks with diabetes have roughly twice the rate of severe hypoglycemia compared to whites with diabetes; it is unclear whether hypoglycemia risk factors identified in studies of white participants are similarly associated with hypoglycemia in blacks.
Methods: We included ARIC participants aged 65+ at Visit 4 (1996-1998) who had Medicare fee-for-service Part B and diagnosed diabetes. We identified severe hypoglycemic events through 2013 using ICD-9 codes from hospitalizations, emergency department visits, and ambulance services. We evaluated previously identified risk factors: age, sex, chronic kidney disease (CKD), diabetes medication use, obesity, cognition, glycemic control, and number of comorbidities. We stratified Cox proportional hazards models by race and used Harrell’s C-statistic to compare discrimination.
Results: There were 33 hypoglycemic events in 135 black participants and 43 hypoglycemic events in 319 white participants (incidence rate 2.8 vs. 1.5 per 100 person-years, p<0.01). Most risk factors had similar associations with risk of hypoglycemia in blacks and whites, with some notable exceptions. Obesity was associated with greater risk in blacks but not whites (Table). CKD was more strongly associated with risk in blacks than whites. Type of diabetes medication was associated with risk in whites but not in blacks. The C-statistic suggested better model discrimination in whites (C=0.795) than in blacks (C=0.759), but confidence intervals were wide.
Conclusion: The direction and strength of risk factors for hypoglycemia may differ for blacks and whites. It is unclear why the relative importance of risk factors for hypoglycemia differ between whites and blacks. These data suggest that the mechanism by which CKD influences hypoglycemia risk may be decreased renal gluconeogenesis in blacks and reduced insulin clearance in whites. Additional research is needed to understand those factors that contribute to hypoglycemia risk in blacks and may underlie health disparities.
Author Disclosures: A.K. Lee: None. B. Warren: None. C.J. Lee: None. E.S. Huang: None. A. Sharrett: None. J. Coresh: None. E. Selvin: None.
- © 2017 by American Heart Association, Inc.