title: Hypoglycemia and adverse outcomes: marker or mediator?
abstract: Multiple studies have shown that hypoglycemia is associated with increased mortality         and a variety of adverse outcomes. Whether hypoglycemia is a mediator of adverse         outcomes or simply represents a marker of critical illness has been unclear until now.         Based on observational data, spontaneous (but not iatrogenic) hypoglycemia is         associated with increased mortality during hospitalization for acute myocardial         infarction. In the recent ADVANCE trial of patients with diabetes, intensive glucose         lowering was associated with increased risk of hypoglycemia. Hypoglycemia was, in         turn, associated with increased risk of macro- and microvascular events and death,         and also with increased risk of noncardiac adverse events, including disorders of the         digestive, respiratory, and skin systems. Based on available evidence, hypoglycemia         does not appear to directly lead to death or cardiovascular events and is likely a         marker for more severe illness and comorbidity burden. Nevertheless, continued efforts         to avoid hypoglycemia are clearly warranted.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kasia J
authors.initials: KJ
authors.lastname: Lipska
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015897:Comorbidity; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents