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The Role of Hypoglycemia in Cardiovascular Outcomes in Diabetes

Breay W Paty1

  • 1Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.

Canadian Journal of Diabetes
|December 15, 2015
PubMed

Insights

Intensive glucose control in diabetes may lower microvascular issues but has unclear cardiovascular benefits. Severe hypoglycemia, a risk of intensive management, is linked to adverse events, possibly as a vulnerability marker.

Area of Science:

  • Endocrinology
  • Cardiology
  • Diabetes Management

Background:

  • Intensive glucose management (targeting lower glycated hemoglobin [A1C] levels) reduces microvascular complications but has uncertain cardiovascular (CV) benefits.
  • Observational studies suggest potential long-term CV benefits, yet trials show no clear reduction in CV events within 3-5 years.
  • Intensive glucose control increases hypoglycemia risk, especially in patients with longstanding diabetes, cognitive impairment, or hypoglycemia unawareness.

Purpose of the Study:

  • To review the current understanding of the association between hypoglycemia and cardiovascular risk.
  • To explore the link between severe hypoglycemia and adverse cardiovascular outcomes.
  • To examine the role of cardiac autonomic neuropathy in hypoglycemia-related CV events.

Main Methods:

  • Review of observational follow-up data from intensive glucose management studies.
  • Analysis of post hoc data from trials like the Action to Control Cardiovascular Risk in Diabetes (ACCORD), Analyses of the Action in Diabetes and Vascular Disease (ADVANCE), and Veterans Affairs Diabetes Trial (VADT).
  • Focus on studies investigating the relationship between hypoglycemia and cardiovascular events.

Main Results:

  • Intensive glucose management did not consistently show a reduction in cardiovascular events over 3-5 years.
  • Severe hypoglycemia is linked to adverse consequences, including cardiac dysrhythmias, CV events, and death.
  • Post hoc analyses suggest cardiac autonomic neuropathy may predispose individuals to CV events.
  • Severe hypoglycemia may act as a marker of vulnerability rather than a direct cause of adverse events.

Conclusions:

  • The precise role of hypoglycemia in cardiovascular outcomes remains uncertain.
  • Severe hypoglycemia may indicate a patient's vulnerability to adverse cardiovascular events.
  • Further research is needed to clarify the complex relationship between glucose control, hypoglycemia, and cardiovascular risk in diabetes.

Keywords:
cardiovascular diseasediabetesdiabètehigh-density lipoproteinshypoglycemiahypoglycémieinsulinothérapie intensiveintensive insulin therapylipoprotéines de haute densitémaladie cardiovasculaire

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