Hypoglycaemia and mortality in type 2 diabetes

Data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study of intensive versus standard glucose control in type 2 diabetes have shown the importance of avoiding severe hypoglycaemia.

Two retrospective studies included over 10,000 patients at high cardiovascular risk with an average follow-up of 3.5 years. Among patients in the intensive control arm, annual mortality was 2.8% if there had been at least one episode of hypoglycaemia requiring assistance, and 1.2% among other patients. The corresponding proportions in the standard control arm were 3.7% and 1.0%. The annual incidence of hypoglycaemia was 3.14% (intensive control) vs 1.03% (standard control).

Increased risk of hypoglycaemia was related to sex (women > men) race (African–Americans > whites), less than high school education, increased age, and use of insulin at trial entry. The risk was lower among patients with a more rapid fall in HbA1c concentration in the first 4 months of the trial.

The occurrence of severe hypoglycaemia is associated with increased mortality among patients with type 2 diabetes and other cardiovascular risk factors.

Bonds DE et al. The association between symptomatic, severe hypoglycaemia, and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 2010;340:137 (2009; 339: b4909); Miller ME et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD STUDY. Ibid: 138 (b5444).