Severe Hypoglycemia Doubles Risk of Death in People With Diabetes

An attack of hypoglycemia that requires an emergency department visit increases the risk for cardiovascular disease or death among people with diabetes.

Highlights:

Hypoglycemia occurs when the level of glucose in the blood drops to below normal
A single episode of hypoglycemia that warrants an emergency department visit could have long-lasting consequences, increasing the risk of death
Health care providers should pay special attention to patients who have been to the emergency department for hypoglycemia

A single episode of blood sugar falling so low as to warrant an emergency department visit nearly doubles the risk of cardiovascular disease or death.

Hypoglycemia (Low Blood Sugar) - Causes, Diagnosis, Treatment, Prevention
Hypoglycemia or low blood sugar often occurs in diabetic patients on insulin treatment. Other conditions like hormone deficiencies can also cause hypoglycemia.

‘Diabetics should actively prevent drastic blood sugar reduction to lower risk of death’

A research team from the Johns Hopkins Bloomberg School of Public Health conducted a large, longitudinal study among older adults with type 2 diabetes.

Around one third of the older adults with diabetes in the study, died within three years of experiencing severe episode of low blood sugar or hypoglycemia.

Variables such as severity of a person's diabetes and the duration since previous diagnosis were controlled for in the study.

Critically Low Blood Sugar Levels Could Trigger Heart Attack
Critically low blood sugar levels could trigger heart attack, it has been shown. People with type two diabetes who suffer episodes of severe hypoglycemia are at greater risk.

Special care should be given to diabetics who have been to the emergency department for complications like loss of consciousness, or seizure associated with hypoglycemia.

"If you have a patient with a history of severe hypoglycemia, this could portend poorly for his or her future," says Alexandra K. Lee, MSPH, a PhD candidate in epidemiology at the Bloomberg School. "Our thinking has been that you resolve a hypoglycemic episode and it's over. But what this tells us is that one episode may have long-lasting consequences."

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Says the study's senior author, Elizabeth Selvin, PhD, a professor of epidemiology at the School "Hypoglycemia is clearly an under-recognized risk factor for death and cardiovascular disease in people with diabetes. We are treating many people in this country for high blood sugar. They need to be very careful that their treatment doesn't go too far and cause hypoglycemia, a potentially more serious condition than we have truly understood."

The efforts to lower blood sugar with medication go too far and, around 1-2 per 100 people with diabetes per year experience severe hypoglycemia, ending in a hospital visit, Lee says.

Diabetes and Hypoglycemia Diabetes is a chronic condition resulting from the inability of the pancreas to produce the hormone insulin or the inability to utilize the insulin effectively to manage the level of glucose (sugar) in the blood.

Uncontrolled diabetes can cause future complications such as blindness, kidney failure and nerve damage.

In 2010, diabetes remains the 7th leading cause of death in the United States. Around 29.1 million or 9.3% of the American population have diabetes while other estimates say that roughly 85% are taking medication to lower their blood sugar, according to the Centers for Disease Control and Prevention.

India has a whopping 30 million and more people who are diabetics. According to a WHO estimate released in 1998, India will have the maximum number of diabetics in the world by 2025.

Hypoglycemia is characterized by abnormally low blood glucose (blood sugar) levels, usually below 70 mg/dl. Few common symptoms include shivering, nervousness or anxiety, sweating, chills and clamminess, irritability or impatience, confusion including delirium, rapid heartbeat, light-headedness or dizziness.

In 2011, about 282,000 adults over 18 years, visited emergency department for hypoglycemia.

Study

The researchers analyzed data from 15,792 participants in the Atherosclerosis Risk in Communities (ARIC) cohort, who were between the ages of 45 and 64 when the study began in 1987

The researchers followed 1,198 participants with type 2 diabetes for an average of 15 years.

Among them 192 experienced hypoglycemia that led to an emergency room visit or hospitalization. Those people were nearly twice as likely to die of any cause than those with diabetes who did not have severe hypoglycemia.

Though diabetic medications like Metformin can bring about benefits to small arteries by lowering blood sugar, if improperly used, they can lower the blood sugar to dangerously levels.

"If the benefit is 10 or 20 years down the line and your patients are in their 70s, maybe we shouldn't be putting them on anti-diabetes medications," Selvin says. "It's something to consider."

The study titled "Association of Severe Hypoglycemia with Cardiovascular Disease and All-Cause Mortality in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study" was written by Alexandra K. Lee; Bethany Warren; Claire J. Lee; Elbert S. Huang; A. Richey Sharrett; Josef Coresh and Elizabeth Selvin.

The findings will be presented at the American Heart Association's EPI|LIFESTYLE 2017 Scientific Sessions in Portland, Ore.

References:

National Diabetes Statistics Report 2017 - (https://www.healthyhubb.com/national-diabetes-report-2017/)
Type 2 Diabetes - Risk Factors - Symptoms & Signs - Management - Prevention - (https://www.medindia.net/patients/patientinfo/type-2-diabetes.htm)
Hypoglycemia (Low Blood Glucose) - (http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html)
Overall Numbers, Diabetes and Prediabetes - (http://www.diabetes.org/diabetes-basics/statistics/)