Hypoglycemia Associated With Variety of Adverse Outcomes

In type 2 diabetes, severe hypoglycemia linked to higher risk of major macro-, microvascular events

WEDNESDAY, Oct. 6 (HealthDay News) -- Severe hypoglycemia is associated with a higher risk of a number of adverse clinical outcomes in type 2 diabetes patients, but the relationship may not be causal, according to research published in the Oct. 7 issue of the New England Journal of Medicine.

Sophia Zoungas, M.D., of the University of Sydney in Australia, and colleagues analyzed data from 11,140 individuals with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, which compared intensive treatment with a formulation of gliclazide to standard glucose lowering.

The researchers found that, over a median follow-up of five years, patients in the intensive group were more likely to have a severe hypoglycemic episode (hazard ratio [HR], 1.86). Severe hypoglycemia was associated with higher risk of major macrovascular events, defined as death from cardiovascular cause or nonfatal myocardial infarction or stroke (HR, 2.88), and major microvascular events, defined as new or worsening nephropathy or retinopathy (HR, 1.81). Higher risks were also seen for nonvascular outcomes such as respiratory, digestive, and skin conditions.

"Although our findings cannot exclude the possibility that severe hypoglycemia has a direct causal link with these outcomes, they 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," the authors conclude.

The study was partly supported by a grant from Servier.

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