Table 1. Outcome counts and occurrence rates, by categories of maximum ambient temperature exposure, by antidiabetes drugs forming the subcohorts of interest.
| Serious hypoglycaemia* | Diabetic ketoacidosis | Sudden cardiac arrest/ventricular arrhythmia | |||||
| Antidiabetes drug class | tmax category, in degrees C | Outcomes, n | Rate†, per 1000 p-y | Outcomes, n | Rate†, per 1000 p-y | Outcomes, n | Rate†, per 1000 p-y |
| Sulfonylureas | <−17.8 | ‡ | 20.6 | NA | – | – | |
| −17.8 to <−12.2 | ‡ | 13.9 | ‡ | 7.8 | |||
| −12.2 to <−6.7 | 78 | 20.8 | 20 | 5.4 | |||
| −6.7 to <−1.1 | 460 | 22.6 | 91 | 4.5 | |||
| −1.1 to <4.4 | 1321 | 23.0 | 197 | 3.4 | |||
| 4.4 to <10.0 | 1752 | 22.8 | 270 | 3.4 | |||
| 10.0 to <15.6 | 3947 | 25.0 | 624 | 3.8 | |||
| 15.6 to <21.1 | 6514 | 25.3 | 1004 | 3.8 | |||
| 21.1 to <26.7 | 7346 | 25.3 | 1139 | 3.8 | |||
| 26.7 to <32.2 | 7101 | 25.1 | 1101 | 3.8 | |||
| 32.2 to <37.8 | 2891 | 26.8 | 456 | 4.2 | |||
| 37.8 to <43.3 | 406 | 36.3 | 54 | 4.6 | |||
| ≥43.3 | 28 | 32.9 | ‡ | 4.7 | |||
| Overall | 31 852 | 26.8 | 4964 | 4.0 | |||
| Meglitinides | <−17.8 | NA | NA | – | – | ||
| −17.8 to <−12.2 | – | – | |||||
| −12.2 to <−6.7 | ‡ | 6.7 | |||||
| −6.7 to <−1.1 | ‡ | 8.1 | |||||
| −1.1 to <4.4 | 13 | 6.1 | |||||
| 4.4 to <10.0 | 20 | 6.7 | |||||
| 10.0 to <15.6 | 35 | 5.9 | |||||
| 15.6 to <21.1 | 62 | 6.4 | |||||
| 21.1 to <26.7 | 63 | 5.7 | |||||
| 26.7 to <32.2 | 68 | 6.7 | |||||
| 32.2 to <37.8 | 28 | 8.2 | |||||
| 37.8 to <43.3 | ‡ | 8.7 | |||||
| ≥43.3 | – | – | |||||
| Overall | 299 | 5.9 | |||||
| DPP-4is | <−17.8 | NA | – | – | – | – | |
| −17.8 to <−12.2 | – | – | – | – | |||
| −12.2 to <−6.7 | – | – | ‡ | 9.4 | |||
| −6.7 to <−1.1 | ‡ | 0.8 | ‡ | 4.3 | |||
| −1.1 to <4.4 | ‡ | 1.0 | 16 | 2.4 | |||
| 4.4 to <10.0 | ‡ | 0.9 | 19 | 2.6 | |||
| 10.0 to <15.6 | ‡ | 0.7 | 38 | 2.9 | |||
| 15.6 to <21.1 | 16 | 0.9 | 53 | 2.8 | |||
| 21.1 to <26.7 | ‡ | 0.3 | 69 | 3.0 | |||
| 26.7 to <32.2 | ‡ | 0.3 | 53 | 2.4 | |||
| 32.2 to <37.8 | ‡ | 0.8 | 29 | 3.3 | |||
| 37.8 to <43.3 | – | – | ‡ | 2.5 | |||
| ≥43.3 | – | – | NA | NA | |||
| Overall | 65 | 0.6 | 292 | 2.8 | |||
| GLP1RAs | <−17.8 | NA | – | – | – | – | |
| −17.8 to <−12.2 | – | – | – | – | |||
| −12.2 to <−6.7 | – | – | – | – | |||
| −6.7 to <−1.1 | – | – | – | – | |||
| −1.1 to <4.4 | – | – | – | – | |||
| 4.4 to <10.0 | – | – | – | – | |||
| 10.0 to <15.6 | ‡ | 0.5 | – | – | |||
| 15.6 to <21.1 | ‡ | 0.4 | ‡ | 1.0 | |||
| 21.1 to <26.7 | ‡ | 1.2 | ‡ | 0.9 | |||
| 26.7 to <32.2 | – | – | ‡ | 2.5 | |||
| 32.2 to <37.8 | – | – | ‡ | 2.3 | |||
| 37.8 to <43.3 | – | – | – | – | |||
| ≥43.3 | – | – | – | – | |||
| Overall | 13 | 0.8 | 21 | 1.4 | |||
The preplanned sensitivity analysis excluding follow-up time uponon initiation of insulin included the study of <11, <11, 73, 400, 1,162, 1,498, 3,289, 5,396, 6,156, 5,968, 2,376, 329, and 26 3 ,899, 9374 and 13 405 outcomes and had occurrence rates of 12.7, 10.0, 21.2, 21.6, 22.2, 21.3, 23.0, 23.1, 23.4, 23.5, 24.7, 33.3, and 35.2 per 1000 p-y for t-max categories <−17.8, −17.8 to <−12.2, −12.2 to <−6.7, −6.7 to <−1.1, −1.1 to <4.4, 4.4 to <10.0, 10.0 to <15.6, 15.6 to <21.1, 21.1 to <26.7, 26.7 to <32.2, 32.2 to <37.8, 37.8 to <43.3, and ≥43.3 degrees C, respectively.
Age and sex adjusted occurrence rates; obtained from generalizedgeneralised estimating equation Poisson regression models and estimated at the mean age and sex. Rates were calculated as outcomes occurring during person-days exposed to the t-max category within each antidiabetes class of interest.
Cell count <11 or would enable back-calculation of a cell <11, therefore value suppressed to comply with the US Department of Health and Human Services CMS Cell Suppression Policy (HHS-0938–2020 F-7420).
C, Celsius; DPP-4is, dipeptidyl peptidase-4 inhibitors; GLP1RAs, glucagonlike peptide one receptor agonists; NA, not applicable, that is, drug-class-outcome pair was not prespecified as ‘of interest’; p-y, person years; tmax, maximum daily ambient temperature