Severe hypoglycemia increased risk for major macrovascular, microvascular events

Zoungas S. N Engl J Med. 2010;363:1410-1418.

Issue: December 2010

Patients with severe hypoglycemia experienced increased risks for a range of adverse clinical outcomes, including macrovascular and microvascular events, and cardiovascular and all-cause mortality, according to findings published in the New England Journal of Medicine.

Researchers involved in the study examined 11,140 patients with type 2 diabetes to determine the relationship between severe hypoglycemia and the risks of macrovascular and microvascular events. Patients were 55 years or older, and were recruited from 215 centers in 20 countries between June 2001 and March 2003. The researchers split patients into two arms — intensive glucose control (n=5,571) and standard glucose control (n=5,569) — and followed them for a median of 5 years.

During follow-up, 231 patients (2.1%) had at least one severe hypoglycemic episode — 150 in the intensive glucose group (2.7%) and 81 in the standard glucose group (1.5%). Severe hypoglycemia was associated with the following increases in adjusted risks: major macrovascular events (HR=2.88; 95% CI, 2.01-4.12), major microvascular events (HR=1.81; 95% CI, 1.19-2.74), death from a CV cause (HR=2.68; 95% CI, 1.72-4.19) and death from any cause (HR=2.69; 95% CI, 1.97-3.67; P<.001 for all four comparisons).

In the concluding remarks of their study, the researchers commented that while their findings cannot exclude the possibility that severe hypoglycemia has a direct causal link with these outcomes, the findings suggest that it is as likely to be a marker of vulnerability to a wide range of adverse clinical outcomes.

“In either case, the presence of severe hypoglycemia should raise clinical suspicion of the patient’s susceptibility to adverse outcomes and prompt action to address this possibility,” they added.

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