scholarly journals Recurrent moderate hypoglycemia exacerbates oxidative damage and neuronal death leading to cognitive dysfunction after the hypoglycemic coma

2017 ◽  
Vol 39 (5) ◽  
pp. 808-821 ◽  
Author(s):  
Gabriela Languren ◽  
Teresa Montiel ◽  
Leticia Ramírez-Lugo ◽  
Israela Balderas ◽  
Gustavo Sánchez-Chávez ◽  
...  
Keyword(s):  
Oxidative Damage ◽  
Neuronal Death ◽  
Antioxidant Defense ◽  
Neuronal Damage ◽  
Severe Hypoglycemia ◽  
Subsequent Episode ◽  
Short Period ◽  
Acute Hypoglycemia ◽  
Recurrent Hypoglycemia

Moderate recurrent hypoglycemia (RH) is frequent in Type 1 diabetes mellitus (TIDM) patients who are under intensive insulin therapy increasing the risk for severe hypoglycemia (SH). The consequences of RH are not well understood and its repercussions on neuronal damage and cognitive function after a subsequent episode of SH have been poorly investigated. In the current study, we have addressed this question and observed that previous RH during seven consecutive days exacerbated oxidative damage and neuronal death induced by a subsequent episode of SH accompanied by a short period of coma, in the parietal cortex, the striatum and mainly in the hippocampus. These changes correlated with a severe decrease in reduced glutathione content (GSH), and a significant spatial and contextual memory deficit. Administration of the antioxidant, N-acetyl-L-cysteine, (NAC) reduced neuronal death and prevented cognitive impairment. These results demonstrate that previous RH enhances brain vulnerability to acute hypoglycemia and suggests that this effect is mediated by the decline in the antioxidant defense and oxidative damage. The present results highlight the importance of an adequate control of moderate hypoglycemic episodes in TIDM.

scholarly journals Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after 24 months RESCUE study

2020 ◽  
Author(s):  
Sara Charleer ◽  
Christophe De Block ◽  
Frank Nobels ◽  
Régis P. Radermecker ◽  
Ine Lowyck ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Acute Hypoglycemia

<b>Objective:</b> In recent years, a growing number of people with type 1 diabetes have access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear due to lack of large studies of long duration. We evaluated whether real-world rtCGM-use up to 24 months offered benefits, in particular to those living with impaired awareness of hypoglycemia (IAH). <p><b>Research Design and Methods:</b> This 24-month, prospective, observational, cohort study followed 441<b> </b>adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. Primary endpoint was evolution of HbA<sub>1c</sub>, with secondary endpoints change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life (QOL) scores. Additionally, we evaluated if people could achieve glycemic consensus targets during follow-up.</p> <p><b>Results:</b> After 24 months, HbA<sub>1c</sub> remained significantly lower compared to baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events year before vs 119 events per 100 patient-years in second year, p<0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly less people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA<sub>1c</sub> <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%, p<0.0001).</p> <p><b>Conclusion:</b> Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related events and diabetes-related days off work were observed, particularly in those with IAH.</p>

scholarly journals Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after 24 months RESCUE study

2020 ◽  
Author(s):  
Sara Charleer ◽  
Christophe De Block ◽  
Frank Nobels ◽  
Régis P. Radermecker ◽  
Ine Lowyck ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Acute Hypoglycemia

<b>Objective:</b> In recent years, a growing number of people with type 1 diabetes have access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear due to lack of large studies of long duration. We evaluated whether real-world rtCGM-use up to 24 months offered benefits, in particular to those living with impaired awareness of hypoglycemia (IAH). <p><b>Research Design and Methods:</b> This 24-month, prospective, observational, cohort study followed 441<b> </b>adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. Primary endpoint was evolution of HbA<sub>1c</sub>, with secondary endpoints change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life (QOL) scores. Additionally, we evaluated if people could achieve glycemic consensus targets during follow-up.</p> <p><b>Results:</b> After 24 months, HbA<sub>1c</sub> remained significantly lower compared to baseline (7.64% [60 mmol/mol] vs 7.37% [57 mmol/mol], p<0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events year before vs 119 events per 100 patient-years in second year, p<0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly less people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA<sub>1c</sub> <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs 25.4%, p<0.0001).</p> <p><b>Conclusion:</b> Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, less acute hypoglycemia-related events and diabetes-related days off work were observed, particularly in those with IAH.</p>

Short and long-term glycemic variability associated with severe hypoglycemia and retinopathy in type 1 diabetes mellitus

2020 ◽  
Author(s):  
Martín Borja Sanz ◽  
Gimeno Sergio Roman ◽  
Peteiro Miranda Carlos Miguel ◽  
Ortez Toro Jose Jorge ◽  
Ana Agudo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Severe Hypoglycemia ◽  
Glycemic Variability ◽  
Short And Long Term

269-OR: Effect of Insulin Degludec on Frequency of Severe Hypoglycemia in Patients with Type 1 Diabetes Prone to Nocturnal Severe Hypoglycemia: The HypoDeg Trial

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 269-OR
Author(s):  
RIKKE M. AGESEN ◽  
AMRA CIRIC ALIBEGOVIC ◽  
HENRIK U. ANDERSEN ◽  
PETER GUSTENHOFF ◽  
TROELS K. HANSEN ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Severe Hypoglycemia ◽  
Insulin Degludec

scholarly journals Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Cusinato ◽  
Mariangela Martino ◽  
Alex Sartori ◽  
Claudia Gabrielli ◽  
Laura Tassara ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Psychological Impact ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Well Being ◽  
Glucose Variability ◽  
Threshold Score ◽  
The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

scholarly journals Predictors of Recurrent Severe Hypoglycemia in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia During the HypoCOMPaSS Study

Diabetes Care ◽  
2019 ◽  
Vol 43 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Anneliese J.S. Flatt ◽  
Stuart A. Little ◽  
Jane Speight ◽  
Lalantha Leelarathna ◽  
Emma Walkinshaw ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Severe Hypoglycemia ◽  
Impaired Awareness

Prevalence of severe hypoglycemia in a cohort of patients with type 1 diabetes

2021 ◽  
Author(s):  
Pedro J. Pinés Corrales ◽  
Cristina Arias Lozano ◽  
Cortes Jiménez Martínez ◽  
Luz M. López Jiménez ◽  
Alejandro E. Sirvent Segovia ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Severe Hypoglycemia

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

Effects of glycemic control on target organ responses to epinephrine in type 1 diabetes

2005 ◽  
Vol 289 (2) ◽  
pp. E258-E265 ◽  
Author(s):  
Deanna Aftab Guy ◽  
Darleen Sandoval ◽  
M. A. Richardson ◽  
Donna Tate ◽  
Stephen N. Davis
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Blood Pressure Response ◽  
Severe Hypoglycemia ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Target Organ ◽  
Epinephrine Infusion ◽  
Glucose Levels

Severe hypoglycemia occurs in intensively treated patients with type 1 diabetes mellitus (T1DM) due in part to deficient epinephrine counterregulatory responses. Previously, we have found that T1DM patients demonstrated a spectrum of altered responses to epinephrine at a variety of target organs compared with nondiabetic healthy subjects. What is not known is whether intensive glycemic control further modifies target organ responses in individuals with T1DM. Therefore, the aim of this study is to assess whether there is tissue specific (liver, muscle, adipose tissue, pancreas and cardiovascular) resistance to epinephrine in intensively controlled (IC) T1DM compared with those with conventional control (CC). Eight IC patients (age 33 ± 4 yr, BMI 24 ± 2 kg/m2, Hb A1C6.7 ± 0.1%), and 11 CC patients (age 35 ± 3 yr, BMI 25 ± 1 kg/m2, Hb A1C9.6 ± 0.1%) underwent two separate randomized, single-blind, 2-h hyperinsulinemic euglycemic clamp studies with (EPI) and without (NO EPI) epinephrine infusion. Epinephrine levels during EPI were similar in all groups (5,197 ± 344 pmol/l). Glucose (5.3 ± 0.1 mmol/l) and insulin levels (515 ± 44 pmol/l) were similar in all groups during the glucose clamps. Endogenous glucose production (EGP) and glucose uptake (Rd) were determined using [3-H3]glucose. Muscle biopsy was performed at the end of each study. IC had a significantly reduced EGP and Rdresponses to EPI compared with CC. Glucagon responses to EPI were similarly blunted in both IC and CC. Free fatty acid and glycerol response to EPI was greater in CC compared with IC. There was a significantly greater systolic blood pressure response to EPI in CC. We conclude that, despite similar epinephrine, insulin, and glucose levels, intensively treated T1DM patients had reduced cardiovascular, skeletal muscle, hepatic, and adipose target organ responses to EPI compared with conventionally treated T1DM patients.

Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study

2021 ◽  
pp. 193229682110497
Author(s):  
Daniel J. DeSalvo ◽  
Nudrat Noor ◽  
Cicilyn Xie ◽  
Sarah D. Corathers ◽  
Shideh Majidi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Quality Improvement ◽  
Clinical Outcomes ◽  
Real World ◽  
Private Insurance ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
Electronic Health Record Data ◽  
Diabetes Patients

Background: The benefits of Continuous Glucose Monitoring (CGM) on glycemic management have been demonstrated in numerous studies; however, widespread uptake remians limited. The aim of this study was to provide real-world evidence of patient attributes and clinical outcomes associated with CGM use across clinics in the U.S. based T1D Exchange Quality Improvement (T1DX-QI) Collaborative. Method: We examined electronic Health Record data from eight endocrinology clinics participating in the T1DX-QI Collaborative during the years 2017-2019. Results: Among 11,469 type 1 diabetes patients, 48% were CGM users. CGM use varied by race/ethnicity with Non-Hispanic Whites having higher rates of CGM use (50%) compared to Non-Hispanic Blacks (18%) or Hispanics (38%). Patients with private insurance were more likely to use CGM (57.2%) than those with public insurance (33.3%) including Medicaid or Medicare. CGM users had lower median HbA1c (7.7%) compared to nonusers (8.4%). Rates of diabetic ketoacidosis (DKA) and severe hypoglycemia were significantly higher in nonusers compared to CGM users. Conclusion: In this real-world study of patients in the T1DX-QI Collaborative, CGM users had better glycemic control and lower rates of DKA and severe hypoglycemia (SH) events, compared to nonusers; however, there were significant sociodemographic disparities in CGM use. Quality improvement and advocacy measures to promote widespread and equitable CGM uptake have the potential to improve clinical outcomes.

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