Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions

Acta Diabetol. 2015 Oct;52(5):889-95. doi: 10.1007/s00592-015-0727-y. Epub 2015 Mar 10.


Aims: Severe hypoglycemia is one of the strongest predictors of adverse clinical outcomes in patients with type 2 diabetes. Our study addressed the question whether there is a relationship between hypoglycemic events (HE) and severe cardiac arrhythmias in type 2 diabetic patients with established clinical risk factors under real-world conditions.

Methods: We included 94 patients with type 2 diabetes and documented cardiovascular disease, in which interstitial glucose values and Holter ECG were recorded for 5 days in parallel. Patients received a stable treatment with insulin and/or sulfonylurea and were instructed to record symptoms of hypoglycemia or arrhythmias.

Results: Continuous glucose monitoring revealed 54 HE (interstitial glucose <3.1 mmol/l) in a total of 26 patients. Patients perceived only 39 % of HE during the day and 11 % of HE during the night. Patients with HE had a significantly higher number of severe ventricular arrhythmias [ventricular tachycardia (VT) 32.8 ± 60 vs. 0.9 ± 4.2, p = 0.019], and multivariate regression analysis revealed the duration of severe HE and TSH level as independent predictors of the occurrence of a VT.

Conclusions: In conclusion, our study suggests that hypoglycemia might be able to trigger at least under certain circumstances, such as low TSH, ventricular arrhythmias under real-world conditions. The large number of unrecognized HE and VT in vulnerable patients treated with insulin or sulfonylurea should encourage the practitioner to focus on stable glucose control and to search for silent HE.

Keywords: CGM; Holter ECG; Hypoglycemia; Type 2 diabetes; Ventricular arrhythmia.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / epidemiology*
  • Cardiovascular Diseases / complications*
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Complications / epidemiology*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Female
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / epidemiology*
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Insulin / adverse effects
  • Insulin / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Risk Factors
  • Sulfonylurea Compounds / adverse effects
  • Sulfonylurea Compounds / therapeutic use


  • Hypoglycemic Agents
  • Insulin
  • Sulfonylurea Compounds