Background: There is limited community-based data on the association of hypoglycemia with cardiovascular events among older individuals, who are particularly susceptible to hypoglycemia.

Methods: We conducted a prospective cohort analysis of adults with diabetes aged ≥70 years from the Atherosclerosis Risk in Communities (ARIC) Study (baseline visit 5, 2011-2013). History of severe hypoglycemia was defined using first position ICD-9 codes from prior hospitalizations, emergency department visits, and ambulance calls through June 1, 2011. We evaluated the rate of cardiovascular events (myocardial infarction, fatal coronary heart disease, stroke or heart failure) and mortality (follow-up through December 31, 2017), using negative binomial and Cox proportional hazards regression models.

Results: Among 2,194 participants with diabetes (mean age: 75 years [SD: 5], 57% female, 32% blacks), 79 had a history of severe hypoglycemia. During a median follow-up of 5.4 years, a history of severe hypoglycemia was strongly associated with cardiovascular disease (incident and recurrent) and death (Table).

Conclusions: Our findings suggest potential cardiovascular benefits of severe hypoglycemia prevention among older individuals and provide strong evidence for relaxing the targets of blood glucose control among older individuals.


J.B. Echouffo Tcheugui: None. N.R. Daya: None. O. Tang: None. B. Windham: None. A. Shah: Advisory Panel; Self; Philips Ultrasound. Consultant; Self; Bellerophon. Other Relationship; Self; Novartis Pharmaceuticals Corporation. E. Selvin: None.

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