Causative anti-diabetic drugs and the underlying clinicalfactors for hypoglycemia in patients with diabetes

Recent clinical trials indicated that the intensiveglycemic control do not reduce cardiovascular diseasemortality among diabetic patients, challenging asignificance of the strict glycemic control in diabetesmanagement. Furthermore, retrospective analysis ofthe Action to Control Cardiovascular Risk in Diabetesstudy demonstrated a significant association betweenhypoglycemia and mortality. Here, we systematicallyreviewed the drug-induced hypoglycemia, and alsothe underlying clinical factors for hypoglycemiain patients with diabetes. The sulfonylurea use issignificantly associated with severe hypoglycemia inpatients with type 2 diabetes. The use of biguanide（approximately 45%-76%） and thiazolidinediones（approximately 15%-34%） are also highly associatedwith the development of severe hypoglycemia. Inpatients treated with insulin, the intensified insulintherapy is more frequently associated with severehypoglycemia than the conventional insulin therapy andcontinuous subcutaneous insulin infusion. Among theunderlying clinical factors for development of severehypoglycemia, low socioeconomic status, aging, longerduration of diabetes, high HbA1c and low body massindex, comorbidities are precipitating factors for severehypoglycemia. Poor cognitive and mental functions arealso associated with severe hypoglycemia.