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Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events Among Older Adults With Diabetes.

  • Echouffo-Tcheugui, Justin B1
  • Daya, Natalie2
  • Lee, Alexandra K3
  • Tang, Olive2
  • Ndumele, Chiadi E4
  • Windham, B Gwen5
  • Shah, Amil M6
  • Selvin, Elizabeth2
  • 1 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD [email protected]
  • 2 Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • 3 Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.
  • 4 Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
  • 5 Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
  • 6 Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Published Article
Diabetes care
Publication Date
Nov 16, 2020
DOI: 10.2337/dc20-0552
PMID: 33199469


To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia. We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 (2011-2013, baseline). Severe hypoglycemia at baseline was defined with use of first position ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke, or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models. Among 2,193 participants (mean [SD] age 76 [5] years, 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted β-coefficient -3.66% [95% CI -5.54, -1.78]), higher LV end diastolic volume (14.80 mL [95% CI 8.77, 20.84]), higher E-to-A ratio (0.11 [95% CI 0.03, 0.18]), and higher septal E/e' (2.48 [95% CI 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio 2.19 (95% CI 1.24, 3.88]) and all-cause mortality (hazard ratio 1.71 [95% CI 1.10, 2.67]) among those without prevalent CVD. Our findings suggest that a history of severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults. © 2020 by the American Diabetes Association.

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