Hanna E. Bloomfield, M.D., M.P.H.
Nancy Greer, Ph.D.
David Newman, M.D.
Roderick MacDonald, M.S.
Maureen Carlyle, M.P.H.
Patrick Fitzgerald, M.P.H.
Indulis Rutks, B.S.
Evidence-based Synthesis Program (ESP) Center
Minneapolis VA Medical Center
Minneapolis, MN; Department of Veterans Affairs; April 2012
Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of
overweight and obesity in many populations. In the VA healthcare system, the prevalence of
diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.
Although people with diabetes have a substantially increased risk of cardiovascular disease
(CVD), recent trials show that intensive glucose lowering does not reduce the risk of CVD death
or all-cause mortality although it reduces the risk of microvascular complications (nephropathy,
retinopathy and neuropathy) and possibly non-fatal myocardial infarction. Intensive glucose
control also increases the risk of hypoglycemic episodes. Several recent meta-analyses of the
trials comparing intensive to conventional glucose control concluded that intensive control
is associated with a 2-2.5 fold increased risk of severe hypoglycemia. The reviews however
have not included smaller randomized trials, trials focused on the comparison of specific drug
regimens, and non-randomized trials. We conducted the current review to provide broader
insight into the incidence of, the risk factors for, and the clinical and social impact of severe
hypoglycemia in adults with type 2 diabetes treated with glucose lowering medications.
The key questions were as follows: In adults with type 2 diabetes treated with one or more