History of Severe Hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease

A Comparative Case Control Study

Keywords: hypoglycemia, coronary artery disease, type 2 diabetes mellitus, C-reactive protein


Objectives. A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH.

Methodology. We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD. 

Results. A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a  higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029).

Conclusion.  In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.


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Author Biographies

Mohd Asyiq Raffali, UKM Medical Centre, Kuala Lumpur, Malaysia

Department of Medicine

Syawal Faizal Muhammad, UKM Medical Centre, Kuala Lumpur, Malaysia

Department of Medicine

Hamzaini Abdul Hamid, UKM Medical Centre, Kuala Lumpur, Malaysia

Department of Radiology

Azmawati Mohammed Nawi, UKM Medical Centre, Kuala Lumpur, Malaysia

Department of Community Health

Nor Azmi Kamaruddin, UKM Medical Centre, Kuala Lumpur, Malaysia

Department of Medicine


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How to Cite
Raffali, M. A., Muhammad, S. F., Abdul Hamid, H., Mohammed Nawi, A., & Kamaruddin, N. A. (2021). History of Severe Hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A Comparative Case Control Study. Journal of the ASEAN Federation of Endocrine Societies, 36(1), 37-44. https://doi.org/10.15605/jafes.036.01.15
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