Severe Hypoglycemia and Incident Heart Failure Among Adults With Type 2 Diabetes

• Published in: The journal of clinical endocrinology and metabolism 2022-02, Vol.107 (3), p.e955-e962
• Main Authors: Echouffo-Tcheugui, Justin B, Kaze, Arnaud D, Fonarow, Gregg C, Dagogo-Jack, Sam
• Format: Article
• Language: English
• Subjects: Adults; Aged; Blood Glucose - analysis; Blood Glucose - drug effects; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes therapy; Epidemiology; Female; Follow-Up Studies; Glycated Hemoglobin - analysis; Heart failure; Heart Failure - epidemiology; Humans; Hypoglycemia - chemically induced; Hypoglycemia - diagnosis; Hypoglycemia - epidemiology; Hypoglycemic Agents - adverse effects; Incidence; Male; Middle Aged; Online Only; Proportional Hazards Models; Prospective Studies; Risk Assessment - statistics & numerical data; Risk Factors; Self Report - statistics & numerical data; Severity of Illness Index; Type 2 diabetes
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgab794

The association of severe hypoglycemia on the incidence of heart failure (HF) is unclear. We evaluated the association of severe hypoglycemia with incident HF among individuals with type 2 diabetes. We included participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Severe hypoglycemia episodes were assessed during the initial 24 months following randomization and defined using 2 methods: (1) symptomatic, severe hypoglycemic event requiring medical assistance (first definition); or (2) requiring any assistance (second definition). Participants without HF at baseline and during the first 24 months of the study were prospectively followed for incident HF hospitalization. Multivariable Cox regression was used to generate adjusted hazard ratios (HR) for the association of severe hypoglycemia and incident HF. Among 9208 participants (mean age 63 years, 38% female, 62% White), 365 had ≥ 1 episode of severe hypoglycemic. Over a median follow-up duration of 3 years, there were 249 incident HF events. After multivariable adjustment for relevant confounders, participants with severe hypoglycemia requiring medical assistance had a 68% higher relative risk of incident HF (HR 1.68; 95% CI, 1.06-2.66), as compared with individuals who never experienced any episode of hypoglycemia. Severe hypoglycemia requiring any assistance was also associated with a 49% higher relative risk of HF (HR 1.49; 95% CI, 1.01-2.21). In a large cohort of adults with type 2 diabetes, severe hypoglycemia was independently associated with greater risk of incident HF.