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Association between severe hypoglycaemia and CV outcomes and mortality

By Colin Kenny, Editor – Diabetes Distilled


In the double-blind study DEVOTE, people living with type 2 diabetes were randomised to receive either insulin degludec (n=3818) or insulin glargine (n=3819). The primary outcome was the first occurrence of an adjudicated major adverse cardiovascular event (MACE). Severe hypoglycaemia was a pre-specified secondary outcome. Here, in the DEVOTE 3 analysis, the associations of severe hypoglycaemia with both MACE and all-cause mortality were examined. In all, 681 participants experienced a MACE event, and 439 individuals experienced a severe hypoglycaemic event during the trial.

Experiencing severe hypoglycaemia at any time was found to be a significant predictor of all-cause mortality, as the risk in participants so affected was 2.5-fold that for the participants who did not experience an event. There was also a higher risk of all-cause mortality up to 1 year after experiencing severe hypoglycaemia compared with no severe hypoglycaemia in the same time interval. These data add to the evidence for an association between severe hypoglycaemia and mortality. However, they do not establish whether hypoglycaemia serves as a risk marker for these events or directly contributes to their occurrence.


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