November 19, 2019
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Severe hypoglycemia can quickly lead to acute coronary syndrome among older patients

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Older adults with diabetes may be more likely to develop acute coronary syndrome if they experience severe hypoglycemia, according to findings published in the Journal of Diabetes Investigation.

Severe hypoglycemia increases the risk of acute coronary syndrome in patients with diabetes, particularly within the first 10 days after a severe hypoglycemic episode,” Tatsuya Noda, MD, PhD, a lecturer in the department of public health, health management and policy at Nara Medical University in Japan, and colleagues wrote. “These findings highlight that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.”

Noda and colleagues identified 7,909,626 adults aged at least 35 years with diabetes in data from 2014 to 2016 in the National Database of Health Insurance Claims and Specific Health Check-ups in Japan. The researchers assessed instances of severe hypoglycemia and acute coronary syndrome (ACS) that led to emergency percutaneous coronary intervention and the time between these two events.

Severe hypoglycemia occurred among 48,118 individuals in the study cohort. According to the researchers, absolute ACS risk was 1.016 times greater for those who experienced severe hypoglycemia vs. those who did not based on fully adjusted models (HR = 1.016; 95% CI, 1.012-1.021). Adults who experienced severe hypoglycemia had an absolute ACS risk of 3 per 1,000 person-years. Adults who did not experience severe hypoglycemia had an absolute ACS risk of 2.7 per 1,000 person-years.

Diabetes glucose test 2 2019 
Older adults with diabetes may be more likely to develop acute coronary syndrome if they experience severe hypoglycemia.
Source: Adobe Stock

Among adults aged at least 70 years, the researchers found an absolute ACS risk of 3.3 per 1,000 person-years for those who experienced severe hypoglycemia and an absolute ACS risk of 3 per 1,000 person-years for those who did not. Among adults younger than 70 years, the researchers found an absolute ACS risk of 2.4 per 1,000 person-years in those who experienced hypoglycemia and an absolute ACS risk of 2.3 per 1,000 person-years for those who did not.

“The results highlight the importance of avoiding a hypoglycemic episode in elderly patients,” the researchers wrote. “Accordingly, many guidelines recommend a less stringent goal for glycemic control in elderly patients with diabetes, who face a higher risk of hypoglycemia.”

In the first 10 days after severe hypoglycemia, the researchers found an absolute ACS risk of 10.6 per 1,000 person-years. Absolute ACS risk was 2.2 per 1,000 person-years in days 11 to 90 and 2.5 per 1,000 person-years in days 91 to 365.

“The risk of ACS was higher immediately after a severe hypoglycemic episode, and this was confirmed by an adjusted regression analysis,” the researchers wrote. “These findings suggest that a severe hypoglycemic episode affects the onset of ACS during the subsequent 10-day period.” – by Phil Neuffer

Disclosures: Noda reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Editor's Note: This article was updated on Nov. 21, 2019, to correctly identify that Tatsuya Noda, MD, PhD, reports no relevant financial disclosures. The editors regret the error.