Nishioka Y, Okada S, Noda T, et al. - Based on national claims data in Japan, researchers conducted a retrospective population-based cohort study to determine acute coronary syndrome (ACS) risk after a severe hypoglycemic episode. Data from diabetes patients aged ≥ 35 years ( n = 7,909,626) were gathered from April 2014 to March 2016. ACS absolute risk was 10.6 out of 1,000 person-years within 10 days of a severe hypoglycemic episode. In elderly diabetes patients, severe hypoglycemia was linked to an increased risk of ACS. ACS risk increased after a severe hypoglycemic episode with a shorter period, indicating that severe hypoglycemia in patients with diabetes leads to an increased risk of ACS. Such outcomes show that while treating diabetes, particularly in elderly patients, it is important to avoid severe hypoglycemia.