Hypoglycemia and Cardiovascular Disease: Lessons from Outcome Studies

Curr Diab Rep. 2015 Dec;15(12):117. doi: 10.1007/s11892-015-0678-2.


Severe hypoglycemia is recognized to be one of the strongest predictors of macrovascular events, adverse clinical outcomes, and mortality in patients with type 2 diabetes. Large clinical trials have reported an increased hazard ratio for all-cause mortality and cardiovascular events in patients with type 2 diabetes and severe hypoglycemia. However, these trials also reported an increased hypoglycemia-associated mortality rate in patients allocated to standard treatment by a factor of 1.5-2 despite a significant 50 % to 70 % lower incidence of hypoglycemia compared to the intensive treatment group. Although the potential for a causal relationship has been demonstrated in mechanistic studies, the evidence from large prospective studies suggest that other pre-existing cardiovascular risk factors in addition to hypoglycemia may be the major link to the final cardiovascular event, and that a low blood glucose level can trigger these events in patients with a high cardiovascular risk.

Keywords: Cardiovascular risk; Diabetes; Hypoglycemia; Outcome trials.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 2 / complications
  • Humans
  • Hypoglycemia / complications*
  • Incidence
  • Outcome Assessment, Health Care
  • Risk Factors