Type 2 Diabetes, Hypoglycemia Worsen Heart Failure Hospitalizations

Mitchel L. Zoler, PhD, for Medscape

May 05, 2022

Researchers published the study covered in this summary on researchsquare.com as a preprint that has not yet been peer reviewed.

Key Takeaways

  • Among 783 patients hospitalized for heart failure at a single center in South Korea the presence of type 2 diabetes and hypoglycemia at admission was a significant independent risk factor for incident major adverse cardiovascular events as well as for all-cause death during follow-up in a retrospective analysis.

  • These significant relationships were independent of traditional cardiovascular risk factors as well as several biomarkers of cardiovascular disease risk.

Why This Matters

  • The authors suggest that clinicians pay more attention to preventing and reducing hypoglycemia in patients hospitalized for heart failure.

  • They also suggest that further studies are needed to investigate the pathogenic mechanisms associated with hypoglycemia for future adverse cardiovascular outcomes and increased mortality in patients hospitalized for heart failure. They also recommend prospective studies to confirm a causal relationship between hypoglycemia and adverse cardiovascular outcomes in patients with type 2 diabetes hospitalized for heart failure.

Study Design

  • This was a retrospective, observational study of 783 consecutive patients ≥ 25 years old and admitted via the emergency department of St. Vincent's Hospital in South Korea for heart failure from March 2016 to June 2018 and followed through June 2021. 

  • The cohort included 386 patients (49%) without type 2 diabetes, 316 (41%) with type 2 diabetes but no hypoglycemia at admission, and 79 patients (10%) with type 2 diabetes and hypoglycemia identified at the time of hospitalization.

  • The authors used Cox proportional hazard regression models to estimate the associations between these three subgroups and major adverse cardiovascular events (MACE) (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke) and all-cause mortality. The models included these prespecified covariates: age, sex, body mass index, history of cardiovascular disease, history of heart failure, heart failure etiology, chronic kidney disease, systolic blood pressure, fasting plasma glucose level, A1c level, left ventricular ejection fraction of 40% or less; use of insulin, sulfonylureas, metformin, antihypertensive medications, aspirin, or statins; levels of the biomarkers troponin-T, NT-pro-BNP, and C-reactive protein.

Key Results

  • The patients averaged 72 years old and nearly half were men. Their heart failure etiology was ischemic heart disease in 29% and non-ischemic heart disease in 71%. Median hospital stay was 6 days.

  • During a median follow-up of 25 months, 158 (20%) patients died and 159 patients (20%) had MACE.

  • In the adjusted models, patients with type 2 diabetes had no significant difference from patients without diabetes for MACE, cardiovascular death, or all-cause death. In adjusted models patients with type 2 diabetes and hypoglycemia had significantly increased rates for all three of these outcomes compared with patients with no diabetes. The adjusted hazard ratios were 2.29 for MACE, 2.88 for cardiovascular death, and 2.58 for all-cause death.


  • The data came entirely from a cohort of Korean patients.

  • The study was retrospective, observational, single-center, and involved a relatively small number of participants. Although the authors adjusted the findings for the baseline prevalence of conventional cardiovascular disease risk factors they acknowledged being unable to control for all the confounding factors that could potentially influence cardiovascular outcomes and death.


  • The study received no commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study, "Impact of Hypoglycemia at the Time of Hospitalization for Heart Failure From Emergency Department on Major Adverse Cardiovascular Events With and Without Type 2 Diabetes," written by researchers at The Catholic University of Korea in Seoul on Research Square provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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