***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE Hypoglycemia is associated with serious health outcomes for patients treated for diabetes . However , the outcome of out patients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown . RESEARCH DESIGN AND METHODS The study population , derived from the National Health Insurance Research Data base released by the Taiwan National Health Research Institutes during 1998–2009 , comprised 77,611 patients with newly diagnosed type 2 diabetes . We design ed a prospect i ve study consisting of r and omly selected hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without hypoglycemia .  We investigated the relationships of hypoglycemia with total mortality and cardiovascular events , including stroke , coronary heart disease , cardiovascular diseases , and all-cause hospitalization . RESULTS There were 1,844 hypoglycemic events ( 500 in patients and 1,344 out patients ) among the 77,611 patients . Both mild ( outpatient ) and severe ( inpatient ) hypoglycemia cases had a higher percentage of comorbidities , including hypertension , renal diseases , cancer , stroke , and heart disease . In multivariate Cox regression models , including diabetes treatment adjustment , diabetic patients with hypoglycemia had a significantly higher risk of cardiovascular events during clinical treatment periods . After constructing a model adjusted with propensity scores , mild and severe hypoglycemia still demonstrated higher hazard ratios ( HRs ) for cardiovascular diseases ( HR 2.09 [ 95 % CI 1.63–2.67 ] ) , all-cause hospitalization ( 2.51 [ 2.00–3.16 ] ) , and total mortality ( 2.48 [ 1.41–4.38 ] ) . CONCLUSIONS Symptomatic hypoglycemia , whether clinical ly mild or severe , is associated with an increased risk of cardiovascular events , all-cause hospitalization , and all-cause mortality . More attention may be needed for diabetic patients with hypoglycemic episodes BACKGROUND Although medical textbooks usually classify fasting plasma glucose < 70 or 80 mg/dL ( < 3.89 or 4.44 mmol/L ) as abnormal , the prognosis for patients with low fasting plasma glucose is unclear . METHODS AND RESULTS We conducted prospect i ve cohort studies among 40 069 men and women to investigate the association between  fasting plasma glucose levels and cardiovascular disease and all-cause mortality .  We documented a U-shaped relation between fasting plasma glucose and mortality . In addition to diabetes and impaired fasting glucose levels , low fasting plasma glucose levels were also associated with high mortality . After multivariate adjustment for age , sex , study population , ethnicity , current smoking status , high blood pressure , total cholesterol , body mass index , triglycerides , history of cardiovascular disease and cancer , and a family history of cardiovascular disease , patients with fasting plasma glucose < 70 mg/dL ( < 3.89 mmol/L ) had a 3.3-fold increased risk of cardiovascular disease mortality , and patients with fasting plasma glucose 70 to 79 mg/dL ( 3.89 to 4.43 mmol/L ) had a 2.4-fold increased risk compared with the risk in patients with fasting plasma glucose 80 to 109 mg/dL ( 4.44 to 6.05 mmol/L ) ( tests for trend P<0.0001 ) . Participants with low  fasting plasma glucose levels also had increased risk of all-cause mortality ( test for trend P<0.0001 ) . CONCLUSIONS Participants with low fasting plasma glucose levels had a high risk of cardiovascular disease and all-cause mortality Objectives : To examine the predisposing factors for hypoglycemia in medical-surgical intensive care unit patients treated with intensive insulin therapy  and to assess its association with mortality . Design : Nested-cohort study within a r and omized controlled trial . Setting : Tertiary care intensive care unit . Participants : Medical-surgical intensive care unit patients with admission blood glucose of > 6.1 mmol/L or 110 mg/dL who were enrolled in a r and omized controlled trial comparing intensive insulin therapy with conventional insulin therapy .  Interventions : None . Exposure : Hypoglycemia was defined as blood glucose ≤2.2 mmol/L or 40 mg/dL and intensive care unit mortality was the primary outcome . Measurements and Main Results : Among the 523 patients included in the study , hypoglycemia occurred in 84 ( 16 % ) . Intensive insulin therapy was independently associated with increased risk of hypoglycemia ( adjusted odds ratio , 50.65 ; 95 % confidence interval , 17.36–147.78 ; p < .0001 ) . Other variables associated with an increased risk of hypoglycemia included female gender , diabetes , Acute Physiology and Chronic Health Evaluation II , mechanical ventilation , continuous veno-venous hemodialysis , and intensive care unit length of stay . When adjusted to potential confounders , hypoglycemia was not significantly associated with increased mortality ( adjusted hazard ratio , 1.31 ; 95 % confidence interval , .70–2.46 ; p = .40 ) . Patients with admission blood glucose of ≤10 mmol/L had an increased mortality with hypoglycemia ( adjusted hazard ratio , 4.43 ; 95 % confidence interval , 1.36–14.44 ; p = .01 ) . Crude analysis showed significant association of mortality with blood glucose levels of ≤1.2 mmol/L ( adjusted hazard ratio , 2.92 ; 95 % confidence interval , 1.05–8.11 ; p = .04 ) . When adjusted analysis was performed , similar trend was seen but was not statistically significant ( adjusted hazard ratio , 2.56 ; 95 % confidence interval , .85–7.70 ; p = .10 ) . Conclusions : Our study showed significant increase of hypoglycemia  with intensive insulin therapy . Although hypoglycemia was not independently associated with increased risk of death , increased mortality could not be excluded with severe hypoglycemia and in patients admitted with blood glucose of ≤10 Objective : Dysglycemia during sepsis is associated with poor outcomes in re source -rich setting s. In re source -limited setting s , hypoglycemia is often diagnosed clinical ly without the benefit of laboratory support . We studied the utility of point-of-care glucose monitoring to predict mortality in severely septic patients in Ug and a. Design : Prospect i ve observational study . Setting : One national and two regional referral hospitals in Ug and a. Patients : We enrolled 532 patients with sepsis at three hospitals in Ug and a. The analysis included 418 patients from the three sites with inhospital mortality data , a documented admission blood glucose concentration , and evidence of organ dysfunction at admission ( systolic blood pressure ≤100 mm Hg , lactate > 4 mmol/L , platelet number < 100,000/&mgr;L , or altered mental status ) . Interventions : None . Measurements and Main Results : We evaluated the association between admission point-of-care blood glucose concentration and inhospital mortality . We also assessed the accuracy of altered mental status as a predictor of hypoglycemia . Euglycemia occurred in 33.5 % ( 140 of 418 ) of patients , whereas 16.3 % ( 68 of 418 ) of patients were hypoglycemic and 50.2 % ( 210 of 418 ) were hyperglycemic . Univariate Cox regression analyses comparing in-hospital mortality among hypoglycemic ( 35.3 % [ 24 of 68 ] , hazard ratio 2.0 , 95 % confidence interval 1.2–3.6 , p = .013 ) and hyperglycemic ( 29.5 % [ 62 of 210 ] , hazard ratio 1.5 , 95 % confidence interval 0.96–2.4 , p = .08 ) patients to euglycemic ( 19.3 % [ 27 of 140 ] ) patients showed statistically significantly higher rates of inhospital mortality for patients with hypoglycemia . Hypoglycemia ( adjusted hazard ratio 1.9 , 95 % confidence interval 1.1–3.3 , p = .03 ) remained significantly and independently associated with inhospital mortality in the multivariate model . The sensitivity and specificity of altered mental status for hypoglycemia were 25 % and 86 % , respectively . Conclusion : Hypoglycemia is an independent risk factor for inhospital mortality in patients with severe sepsis and can not be adequately assessed by clinical examination . Correction of hypoglycemia may improve outcomes of critically ill patients in re source -limited setting BACKGROUND Improved blood-glucose control decreases the progression of diabetic microvascular disease , but the effect on macrovascular complications is unknown . There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation . We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a r and omised controlled trial . METHODS 3867 newly diagnosed patients with type 2 diabetes , median age 54 years ( IQR 48 - 60 years ) , who after 3 months ' diet treatment had a mean of two fasting plasma glucose ( FPG ) concentrations of 6.1 - 15.0 mmol/L were r and omly assigned intensive policy with a sulphonylurea ( chlorpropamide , glibenclamide , or glipizide ) or with insulin , or conventional policy with diet . The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group , the aim was the best achievable FPG with diet alone ; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment :  any diabetes-related endpoint ( sudden death , death from hyperglycaemia or hypoglycaemia , fatal or non-fatal myocardial infa rct ion , angina , heart failure , stroke , renal failure , amputation [ of at least one digit ] , vitreous haemorrhage , retinopathy requiring photocoagulation , blindness in one eye , or cataract extraction ) ; diabetes-related death ( death from myocardial infa rct ion , stroke , peripheral vascular disease , renal disease , hyperglycaemia or hypoglycaemia , and sudden death ) ; all-cause mortality . Single clinical endpoints and surrogate sub clinical endpoints were also assessed . All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy . FINDINGS Over 10 years , haemoglobin A1c ( HbA1c ) was 7.0 % ( 6.2 - 8.2 ) in the intensive group compared with 7.9 % ( 6.9 - 8.8 ) in the conventional group -- an 11 % reduction . There was no difference in HbA1c among agents in the intensive group . Compared with the conventional group , the risk in the intensive group was 12 % lower ( 95 % CI 1 - 21 , p=0.029 ) for any diabetes-related endpoint ; 10 % lower ( -11 to 27 , p=0.34 ) for any diabetes-related death ; and 6 % lower ( -10 to 20 , p=0.44 ) for all-cause mortality . Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25 % risk reduction ( 7 - 40 , p=0.0099 ) in microvascular endpoints , including the need for retinal photocoagulation . There was no difference for any of the three aggregate endpoints between the three intensive agents ( chlorpropamide , glibenclamide , or insulin ) . Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis ( both p<0.0001 ) . The rates of major hypoglycaemic episodes per year were 0.7 % with conventional treatment , 1.0 % with chlorpropamide , 1.4 % with glibenclamide , and 1.8 % with insulin .  Weight gain was significantly higher in the intensive group ( mean 2.9 kg ) than in the conventional group ( p<0.001 ) , and patients assigned insulin had a greater gain in weight ( 4.0 kg ) than those assigned chlorpropamide ( 2.6 kg ) or glibenclamide ( 1.7 kg ) . INTERPRETATION Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications , but not macrovascular disease , in patients with type 2 diabetes . ( ABSTRACT TRUNCATED OBJECTIVE Frequent episodes of severe hypoglycemia may increase the risk of cardiovascular 
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Conclusions This is the first study demonstrating that hypoglycemia was associated with comparable risk ratios in different study population s and various study endpoints , and a trend of a dose-dependent relationship between hypoglycemia severity and adverse events .
The findings of this systematic review support the speculation that hypoglycemia is a risk factor for adverse vascular events and mortality