A 3-year cohort study found that in type 2 diabetes patients, renal function was significantly worse after severe hypoglycemia with blood pressure surge, compared with those without blood pressure surge.

The study was conducted in 111 type 2 diabetes patients with severe hypoglycemia and in that 76 exhibited an extremely high systolic blood pressure before treatment, whereas 35 demonstrated no such increase (179.1 ± 27.7 mmHg vs. 131.1 ± 20.2 mmHg, P < 0.001). At 12 h after treatment, systolic blood pressure did not differ significantly (131.5 ± 30.7 mmHg vs. 123.5 ± 20.7 mmHg; P = 0.39). The estimated glomerular filtration rate (GFR) before and at the time of severe hypoglycemia did not significantly differ between both groups. A multivariate Cox proportional hazards regression analysis revealed that blood pressure surge during severe hypoglycemia was independently associated with a composite outcome of a more than 15 mL/min/1.73 m2 decrease in the estimated GFR and initiation of chronic dialysis (hazard ratio, 2.68; 95% confidence interval, 1.12–6.38; P = 0.02).

This study concludes that renal function after severe hypoglycemia was significantly worse in type 2 diabetes patients with blood pressure surge during severe hypoglycemia than those without blood pressure surge. These results indicate that in addition to aggressive prevention of severe hypoglycemic episodes, clinicians who manage patients with type 2 diabetes should pay more attention to blood pressure elevations during these episodes. The development and progression of renal dysfunction in type 2 diabetes patients leads to renal replacement therapy and is a strong predictor of cardiovascular events.