Two new studies show that severe hypoglycemia can be common even among patients with poorly controlled diabetes, contrary to conventional wisdom, and that hypoglycemia’s association with cardiovascular disease cannot be solely explained by confounding factors.

 

A Diabetes Care study examined the relationship between self-reported episodes of severe hypoglycemia among some 9000 Kaiser Permanente patients and glycated hemoglobin values measured roughly 4 months earlier. The researchers note a U-shaped relationship, with patients at the lowest and highest levels of hemoglobin likely to have experienced hypoglycemia. They say hypoglycemia was “common at all levels of glycemic control,” affecting 11% of patients in the past year.

A BMJ meta-analysis of six studies encompassing over 900,000 people finds that hypoglycemia is associated with a roughly twofold increase in cardiovascular disease. This was not due to confounding. The authors say their findings point to an advantage for glucose-lowering agents with a low likelihood of inducing hypoglycemia (e.g., metformin).