Iatrogenic hypoglycemia as a serious medical problem


Authors: Emil Martinka 1;  Michaela Mišaníková 1,2
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa 1;  Jesseniova lekárska fakulta Univerzity Komenského v Martine 2
Published in: Forum Diab 2016; 5(2): 76-85
Category: Topic

Overview

Iatrogenic hypoglycemia represents a serious medical problem. This phenomenon not only limits intensification of glycemic control, but it is also associated with an increased risk of cardiovascular and overall morbidity and mortality. Furthermore it is a frequent adverse effect the frequency of which increases with intensifying the glycemic control as well as therapeutic steps. The issue of iatrogenic hypoglycemia and its relating adverse effect and potential cardiovascular as well as overall risk is a very frequently discussed topic. However these problems need to be considered from multiple points of view. Hypoglycemia, especially its severe stages, is indisputably a serious risk factor which increases both cardiovascular (CV) and overall mortality. In respect of CV mortality this mainly involves induction of ischemia and fatal cardiac arrhythmia. Overall mortality is due to accidents, falls and neurological causes (coma, spasms, cognitive dysfunction). Mortality risk related to hypoglycemia is independent of the intensity of glycemic control and the attained level of compensation. A very important factor for evaluating the risk of hypoglycemia is the patient’s “terrain”, and a need of individualization when deciding about the goals and method of glycemic control. The tendency to hypoglycemia in individual patients who receive the same treatment and reach the same levels of glycemic control is different, and according to some authors it reveals a kind of “more vulnerable, or more ill” patients with comorbidities (hepatic, renal, endocrine or oncological) and less stable body defences, which may in itself increase both the cardiovascular and overall mortality. Hypoglycemia therefore represents not only a risk factor, but also a marker identifying patients at risk. Although the relation between hypoglycemia and increased mortality remains a matter of discussion, the therapeutic procedures with a low risk of hypoglycemia and verified cardiovascular and oncological safety are preferred.

Key words:
diabetes – hypoglycemia – mortality


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