Severe hypoglycemia and risk of hospitalization for heart failure in adults with diabetes treated with oral medications with or without insulin: A population-based study

Aims: We aimed to determine if severe hypoglycemia (SH) independently increases the risk of hospitalization for heart failure (hHF) in type 2 diabetes, regardless of the prevalent or incident cardiovascular disease (CVD). Methods: This was a nationwide population-based propensity score-matched study using Korean National Health Insurance Service data (2002–2018). The hazards of hHF were compared in individuals who experienced SH (n = 8,965) and 1:3 matched controls, among adults with diabetes using oral anti-diabetes medications (OADs) with or without insulin and without previous hHF at baseline. Results: During 236,417 person-years, 1,189 cases of hHF occurred. The hazard of hHF was higher in individuals with SH compared to matched controls (adjusted hazard ratio [aHR] 1.503, 95 % confidence interval [CI] 1.324–1.707). The increase in aHR remained significant when excluding participants with prevalent or incident major adverse cardiovascular events (MACE; aHR 1.352, 95 % CI 1.228–1.622) and any CVD (aHR 1.342, 95 % CI 1.025–1.756). Two or more SH events were associated with further increase in hHF risk. Conclusion: SH was associated with increased risks of hHF among adults with diabetes using OAD with or without insulin. The increased risk was attenuated but remained significant in those without prevalent or incident MACE or CVDs.