Cardiovasc Prev Pharmacother.  2022 Jul;4(3):106-113. 10.36011/cpp.2022.4.e13.

Severe hypoglycemia as a risk factor for cardiovascular outcomes in patients with type 2 diabetes: is it preventable?

• Ko SH

• KMID: 2532276
• DOI: http://doi.org/10.36011/cpp.2022.4.e13

Abstract

Hypoglycemia in people with type 2 diabetes mellitus (T2DM) is troublesome and an important barrier to diabetes management. Although more intensive glycemic control is emphasized to prevent diabetes-related long-term complications, it raises the risk of hypoglycemia in people with T2DM. Severe hypoglycemia (SH), defined as critical events characterized by altered mental and/or physical status requiring assistance for recovery, is considered an advanced and life-threatening form of hypoglycemia. The detection of SH is an important issue because it is associated with further adverse clinical outcomes such as cardiovascular events, mortality, cognitive impairment, and decreased quality of life. By identifying the potential risk factors for SH and introducing measures to minimize SH, SH itself and subsequent harmful clinical outcomes could be prevented in people with T2DM. The traditional risk factors for SH in T2DM, such as older age, long-standing diabetes with decreased insulin secretion, advanced vascular complications, serious comorbidities, and insulin use, are usually unmodifiable. However, unhealthy lifestyle factors, defined as current smoking, heavy alcohol consumption, and lack of regular exercise, can be improved through active patient education. In recent research, greater adherence to healthy lifestyle factors and any improvement in unhealthy lifestyle habits were found to be associated with a substantially lower risk of SH in individuals with T2DM. As well as being an essential component of diabetes self-care and optimal glycemic control, lifestyle modification probably contributes to the prevention of SH in individuals with T2DM.

Keyword

Type 2 diabetes mellitus; Severe hypoglycemia; Cardiovascular events; Lifestyle modification

Figure

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  Fig. 1. Trends in the prevalence of severe hypoglycemia in patients with type 2 diabetes mellitus in Korea between 2002 and 2019 using the Korean National Health Insurance Service database (shown as gray bars). Severe hypoglycemia was more prevalent in female patients (red dotted line), and dramatically increased with age.

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  Fig. 2. Severe hypoglycemia (SH) incidence according to the change in each lifestyle behavior in patients with type 2 diabetes mellitus in Korea. In addition to adherence to a healthy lifestyle, any improvement in unhealthy lifestyle factors between the two consecutive health examinations was significantly associated with a lower risk of a subsequent SH event. For example, in case of smoking, compared to nonsmokers for the study period, the hazard ratios for SH in patients with type 2 diabetes mellitus who started smoking, stopped smoking, and maintained smoking were 1.32, 1.17, and 1.30, respectively. Unhealthy lifestyle factors are current smoking, heavy alcohol consumption (≥30 g/day), or lack of regular exercise (moderate-intensity physical activity for <30 min/day, <5 times/wk or strenuous-intensity physical activity for <20 min/day, <3 times/wk). The values are presented as hazard ratio (95% confidence interval).

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