Meta-Analysis: Association between Hypoglycaemia and Serious Adverse Events in Older Patients

• Published in: Journal of diabetes and its complications 2016-07, Vol.30 (5), p.811-818
• Main Authors: Mattishent, Katharina, Loke, Yoon Kong
• Format: Article
• Language: English
• Subjects: Accidental Falls - mortality; Age; Aged; Aged, 80 and over; Aging; Cardiovascular disease; Comorbidity; Confidence intervals; Diabetes; Diabetes mellitus; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - etiology; Diabetic Angiopathies - mortality; Endocrinology & Metabolism; Evidence-Based Medicine; Falls; Fractures; Fractures, Bone - epidemiology; Fractures, Bone - etiology; Fractures, Bone - mortality; Frail Elderly; Glucose; Heart attacks; Hospital costs; Humans; Hypoglycaemia; Hypoglycemia - epidemiology; Hypoglycemia - mortality; Hypoglycemia - physiopathology; Insulin; Meta-analysis; Mortality; Observational Studies as Topic; Older people; Studies; Vascular Diseases - epidemiology; Vascular Diseases - etiology; Vascular Diseases - mortality
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2016.03.018

Abstract Aims We aimed to conduct a meta-analysis of serious adverse events (macro- and micro-vascular events, falls and fractures, death) associated with hypoglycaemia in older patients. Methods We searched MEDLINE and EMBASE spanning a ten-year period up to March 2015 (with automated PubMed updates to October 2015). We selected observational studies reporting on hypoglycaemia and associated serious adverse events, and conducted a meta-analysis. We assessed study validity based on ascertainment of hypoglycaemia, adverse events and adjustment for confounders. Results We included 17 studies involving 1.5 million participants. Meta-analysis of eight studies demonstrated that hypoglycemic episodes were associated with macrovascular complications, odds ratio (OR) 1.83 (95% Confidence Interval [CI] 1.64, 2.05), and microvascular complications in two studies OR 1.77 (95% CI 1.49, 2.10). Meta-analysis of four studies demonstrated an association between hypoglycaemia and falls or fractures, OR 1.89 (95% CI 1.54, 2.32) and 1.92 (95% CI 1.56, 2.38) respectively. Hypoglycaemia was associated with increased likelihood of death in a meta-analysis of eight studies, OR 2.04 (95% Confidence Interval 1.68, 2.47). Conclusion Our meta-analysis raises major concerns about a range of serious adverse events associated with hypoglycaemia. Clinicians should prioritize individualized therapy and closer monitoring strategies to avoid hypoglycaemia in susceptible older patients.