title: Meta-analysis: Association between hypoglycaemia and serious adverse events in older patients.
abstract: We aimed to conduct a meta-analysis of serious adverse events (macro- and microvascular events, falls and fractures, death) associated with hypoglycaemia in older patients.
  
  
  
  We searched MEDLINE and EMBASE spanning a ten-year period up to March 2015 (with automated PubMed updates to October 2015). We selected observational studies reporting on hypoglycaemia and associated serious adverse events, and conducted a meta-analysis. We assessed study validity based on ascertainment of hypoglycaemia, adverse events and adjustment for confounders.
  
  
  
  We included 17 studies involving 1.86 million participants. Meta-analysis of eight studies demonstrated that hypoglycemic episodes were associated with macrovascular complications, odds ratio (OR) 1.83 (95% confidence interval [CI] 1.64, 2.05), and microvascular complications in two studies OR 1.77 (95% CI 1.49, 2.10). Meta-analysis of four studies demonstrated an association between hypoglycaemia and falls or fractures, OR 1.89 (95% CI 1.54, 2.32) and 1.92 (95% CI 1.56, 2.38) respectively. Hypoglycaemia was associated with increased likelihood of death in a meta-analysis of eight studies, OR 2.04 (95% Confidence Interval 1.68, 2.47).
  
  
  
  Our meta-analysis raises major concerns about a range of serious adverse events associated with hypoglycaemia. Clinicians should prioritize individualized therapy and closer monitoring strategies to avoid hypoglycaemia in susceptible older patients.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
authors.forename: Katharina
authors.initials: K
authors.lastname: Mattishent
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK. Electronic address: y.loke@uea.ac.uk.
authors.forename: Yoon Kong
authors.initials: YK
authors.lastname: Loke
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016330:Frail Elderly; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D009026:Mortality; D064887:Observational Studies as Topic; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality
keywords: Cardiovascular disease; Diabetes mellitus; Falls; Fractures; Hypoglycaemia