Severe Hypoglycemia, Cardiac Structure and Function, and Risk of Cardiovascular Events among Older Adults with Diabetes

Objective: To assess the association of severe hypoglycemia measured at baseline with cardiovascular disease (CVD) among community-dwelling older individuals with diabetes, a group particularly susceptible to hypoglycemia.

Methods: We included older adults with diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011–2013, baseline). Severe hypoglycemia at baseline was defined using first position ICD-9 codes, from hospitalizations, emergency department visits, and ambulance calls. We examined cross-sectional associations of severe hypoglycemia with echocardiographic indices of cardiac structure-function. We prospectively evaluated the risks of incident or recurrent CVD (coronary heart disease, stroke or heart failure) and all-cause mortality, from baseline to 31 December 2018, using negative binomial and Cox regression models.

Results: Among 2,193 participants (mean age: 76 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia at baseline. Severe hypoglycemia was associated with a lower left ventricular (LV) ejection fraction (adjusted beta coefficient: -3.7 % [95% CI: -5.5, -1.7]), higher LV end diastolic volume (14.8 ml [95% CI: 8.8, 20.8]), higher E/A ratio (0.11 [95% CI: 0.03, 0.18]), and higher septal E/e’ (2.48 [95%CI: 1.13, 3.82]). In adjusted models, severe hypoglycemia was associated with incident or recurrent CVD (incidence rate ratio [IRR]: 2.49 (95% CI 1.4, 4.39]) and all-cause mortality (HR 1.70 [95% CI 1.10, 2.67]) among those without prevalent CVD.

Conclusions: Our findings suggest that a history severe hypoglycemia is associated with alterations in cardiac function and is an important marker of future cardiovascular risk in older adults.