Medications Most Commonly Associated with Emergency Admissions in Patients >65 Years of Age Budnitz et al. Hypoglycemia Accounts for Most Endocrine-related Emergency Hospital Admissions Budnitz et al. ADVANCE: Severe Hypoglycemia is Associated with Increased Risk of Adverse Outcomes Zoungas at al.
ACCORD: Severe Hypoglycemia is Associated with Increased Risk of Death Launer et al for the ACCORD Study Group. Association of Hypoglycemia with Acute Cardiovascular Events in T2DM Retrospective, observational study (n=860,845) assessing association between hypoglycaemia and acute CV events 3.1% patients had a hypoglycemic event during evaluation period (1 year) Patients who experienced hypoglycemia had a 79% higher odds of an acute CV event than patients without hypoglycaemia Johnston et al.

Severe Hypoglycemia Increases the Risk of CVD and Microvascular Complications in the Elderly Zhao et al. Risk of Severe Hypoglycemia Increases with Baseline Poor Cognitive Function: Importance of early recognition when starting insulin Launer et al for the ACCORD Study Group. Hypoglycemia is Frequently Unrecognized by Patients Many episodes are asymptomatic; CGMS data show that unrecognised hypoglycaemia is common in people with insulin- treated diabetes In one study, 63% of patients with type 1 diabetes and 47% of patients with type 2 diabetes had unrecognised hypoglycaemia as measured by CGMS (n=70) 1 In another study, 83% of hypoglycaemic episodes detected by CGMS were not detected by patients with type 2 diabetes (n=31) 2 CGMS, continuous glucose monitoring system 1. Risk of Hypoglycemia during Sleep No symptoms detectable during sleep Catecholamine responses are diminished 1 May not impair cognitive function the next day 2,3 Subjective well-being affected with greater fatigue during exercise 3 May induce impaired awareness of hypoglycaemia the next day 4 1. Beware of Patients with Hypoglycemia Unawareness Hypoglycemia unawareness affects 20–25% of adults T1DM 10% 1 insulin-treated T2DM Risk of severe hypoglycaemia is 3 to 6 fold greater 2 Broad spectrum of severity 1.

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