Association of severe hypoglycemia with all-cause mortality and complication risks among patients with type 2 diabetes mellitus in China

Aims: To investigate the association of severe hypoglycemia (SH) with all-cause mortality and complication risks among Chinese patients with type 2 diabetes mellitus (T2DM). Methods: Cohort study and nested case-control studies were conducted based on medical insurance database 2008-2015. The incidence of outcomes or the exposure of previous SH was compared among matched patients, respectively. The association between SH and outcomes was investigated and validated by different models. Results: Among cohort study participants (mean age of 59.0 +/- 11.2 years), SH was associated with higher risk of all-cause mortality (HR = 1.80, P < 0.001) and transient ischemic attacks (TIA, HR = 1.51, P < 0.001), while no association was observed between SH and complications including myocardial infarction (MI), angina, arrhythmia and stroke. Similarly, SH was associated with about doubled all-cause mortality (OR = 1.76, P < 0.001) and TIA (OR = 2.00, P < 0.001), but not associated with risk of MI or stroke in nested case-control studies. Conclusions: In Chinese patients with T2DM, SH is associated with increased risk of all cause mortality and TIA, but no significant differences were found regard to the other examined complication risks, which need to be further explored in future studies. (c) 2020 Elsevier B.V. All rights reserved.