jkd The Journal of Korean Diabetes J Korean Diabetes 2233-7431 2714-0547 Korean Diabetes Association 10.4093/jkd.2016.17.1.17 jkd-17-17 Focused Issue Hypoglycemic Morbidity and Mortality in Diabetes SonJang Won Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea Corresponding author: Jang Won Son Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea, E-mail: jwsonmd@gmail.com 01 2016 10 01 2016 17 1 17 23 29012016 02022016 Copyright © 2016 Korean Diabetes Association 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Iatrogenic hypoglycemia is a major obstacle to glycemic control in patients with diabetes. Hypoglycemia has been associated with greater risk of cardiovascular disease (CVD) and mortality among patients with diabetes. Recent large randomized clinical trials have shown conflicting results regarding the impact of intensive glycemic control on CVD prevention in patients with diabetes. There is growing consensus that hypoglycemia is a possible cause for the lack of benefit on cardiovascular morbidity and mortality in large-scale diabetes outcomes trials. Acute hypoglycemia causes a cascade of physiologic effects, including hemodynamic changes, pro-thrombotic reactions and cardiac arrhythmias, presenting several potential mechanisms through which hypoglycemic events may increase cardiovascular risk. However, recent studies do not support a temporal or dose-response relationship between hypoglycemia and longterm cardiovascular risk in patients with diabetes. Recently, severe hypoglycemia was suggested as a predictor of adverse outcomes in patients with diabetes. Thus, individualized therapy was recommended in order to avoid severe hypoglycemia and any related adverse cardiovascular outcomes in patients with diabetes.

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