Hypoglycaemia has long been recognised as a dangerous side-effect of treatment of diabetes with insulin or insulin secretagogues. With its potential to disrupt cerebral function, hypoglycaemia can have a major effect on peoples' lives. Study findings have suggested that hypoglycaemia is associated with an increased risk of cardiovascular events and mortality. Different mechanisms by which hypoglycaemia might provoke cardiovascular events have been identified in experimental studies, and in clinical studies cardiac arrhythmias have been reported to be induced by hypoglycaemia, with one report describing sudden death during a severe episode. Emerging evidence suggests that the association between hypoglycaemia and cardiovascular events and mortality is likely to be multifactorial. The association is probably partly caused by confounding, with hypoglycaemia occurring more frequently in people with comorbidities who are also more likely to die than those without. However, people with type 1 or type 2 diabetes also seem at risk of hypoglycaemia-induced cardiovascular effects. This risk should be recognised by clinicians when agreeing glycaemic goals with patients and choosing appropriate glucose-lowering therapies.
Bibliographical noteFunding Information:
BMF has served as a consultant or speaker for Novo Nordisk, Lilly, Boehringer Ingelheim, Roche, Abbott, and MSD. SRH has served as a consultant or speaker from Lilly, Novo Nordisk, Takeda, Boeringher Ingelheim, Mannkind, Sanofi, Zealand Pharma and UN-EEG. RJM has served as a consultant or speaker for Novo Nordisk, Sanofi, Eli Lilly and has received research grant support from Novo Nordisk and the Helmsley Trust. KK has served as a consultant or speaker for AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi and has received research grant support from AstraZeneca, Boehringer Ingelheim, Lilly, Novartis, Novo Nordisk, Roche, and Sanofi. PA has served on scientific advisory boards, served as a speaker, or both for AstraZeneca, Boehringer Ingelheim/Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck Sharp & Dohme (MSD), Novartis, and Sanofi. BC has served as a consultant or speaker for Xeris Pharmaceuticals. PEC has served as a consultant or speaker to Novo Nordisk. LG-F has served as a consultant or speaker for Abbott Diabetes Care, AstraZeneca, Dexcom, Johnson and Johnson, and Merck and received research funding from Abbott Diabetes Care. LG-F distributes and licences for the Hypoglycemia Fear Survey through HFS-Global LLC in agreement with the University of Virginia Licensing and Ventures Group. ERS has served as a consultant or speaker for Sanofi, Lilly, Zucara, MannKind, NovoNordisk, and WebMD and has received research funding from Lilly. BEdG has served on scientific advisory boards for Novo Nordisk and received research grant support from AstraZeneca and Sanofi. TJ has served as a consultant or speaker for Novo Nordisk, Lilly, Medtronic, and Sanofi. SZ has served as a consultant or speaker for AstraZeneca, Novo Nordisk, and MSD Australia. LAL has acted as a consultant or speaker for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi, and Servier and has received research grant support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen, Novo Nordisk, and Sanofi. UP-B has served as a consultant or speaker for AstraZeneca, Bristol-Myers Squibb, Novo Nordisk, Sanofi-Aventis, UN-EEG and has received research grant support from Novo Nordisk. SAA and YL declare no competing interests.
The International Hypoglycaemia Study Group (IHSG) is supported through an unrestricted educational grant from Novo Nordisk, awarded to the University of Sheffield (Sheffield, UK) on behalf of the members of the IHSG. The rationale for the formation of IHSG is that hypoglycaemia is an under-recognised problem that deserves greater awareness and focus across the health-care community. The group's ultimate goal is to improve the lives of patients with diabetes. Novo Nordisk representatives had no role in the design or content of the Review, were unaware of its content, and had no right to approve or disapprove the final content.
© 2019 Elsevier Ltd