A history of severe hypoglycemia may be associated with alterations in cardiac function in older adults with type 2 diabetes (T2D), according to the results of a study published in Diabetes Care.

While studies have shown that hypoglycemia is common in older adults with T2D and that severe hypoglycemia is strongly associated with cardiovascular risk, the consequences of hypoglycemia on cardiac functioning have not extensively been studied in this population.

In this study, 2193 individuals (mean age, 76±5 years; 57% women; 32% African Americans) with diabetes were enrolled. Individuals were included if they self-reported a diagnosis of T2D by a physician and had no missing data.

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In this cohort, 3.6% of participants had a history of severe hypoglycemia at baseline. These individuals were older and more likely to be Black or to use insulin than individuals without a history of severe hypoglycemia. Individuals with vs without a history of severe hypoglycemia had: lower left ventricular ejection fraction, lower right ventricular fractional area change, as well as differences in left ventricular end-diastolic diameter, septal thickness, mean wall thickness, left ventricular mass, left ventricular end-diastolic volume, left ventricular end-systolic volume, global longitudinal strain, left atrial volume, and E-to-A ratio.

A total of 559 participants died and 136 experienced an incident or recurrent cardiovascular disease event. When adjusting for diabetes duration and medication use, individuals with vs without a history of severe hypoglycemia had a significantly higher risk for recurrent cardiovascular events and all-cause mortality.

Limitations to this study include its cross-sectional nature, which prevents temporal analysis of observed associations. Additionally, the population of individuals with a history of severe hypoglycemia was relatively small, limiting the analytical power of the data.

“[O]ur findings reinforce the concerns about hypoglycemia among older adults. Our study demonstrates that a history of severe hypoglycemia is an important marker of concurrent and future cardiovascular risk,” concluded the study authors. “Prevention of severe hypoglycemia and mitigation of cardiovascular risk among older adults with diabetes should be a priority.”


Echouffo-Tcheugui JB, Daya N, Lee AK, et al. Severe hypoglycemia, cardiac structure and function, and risk of cardiovascular events among older adults with diabetes. [published online November 16, 2020]. Diabetes Care. doi:10.23337/dc20-0552