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Nguyen É, Wong K, Lalanne-Mistrih ML, Rabasa-Lhoret R, Brazeau AS. Association between low-carbohydrate-diet score, glycemia and cardiovascular risk factors in adults with type 1 diabetes. Nutr Metab Cardiovasc Dis 2024; 34:2143-2154. [PMID: 38866607 DOI: 10.1016/j.numecd.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND AIMS Low-carbohydrate-diets (LCDs) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diets on glycemia and cardiovascular risk factors is debated. This study aims to evaluate associations between low-carbohydrate intakes using LCD score with glycemia and cardiovascular risk factors (lipid profile) in adults with T1D or LADA in Québec, Canada. METHODS AND RESULTS This is a cross-sectional study using data collected in the BETTER registry (02/2019 and 04/2021) including self-reported 24-h dietary recalls to calculate LCD scores, waist circumference, level-2 and level-3 hypoglycemic episodes and measured biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). Participants were divided into quartiles (Q) based on LCD scores. Two hundred eighty-five adults (aged 48.2 ± 15.0 years; T1D duration 25.9 ± 16.2 years) were included. Categorical variables underwent Chi-squared/Fisher's Exact tests, while continuous variables underwent ANOVA tests. Mean carbohydrate intake ranged from 31.2 ± 6.9% (Q1) to 56.5 ± 6.8% (Q4) of total daily energy. Compared to Q4, more people in Q1 reported HbA1c ≤ 7% [≤53.0 mmol/mol] (Q1: 53.4% vs. Q4: 29.4%; P = 0.011). The same results were found in the models adjusted for age, sex and T1D duration. A greater proportion of participants in Q1 never experienced level-3 hypoglycemia compared to Q3 (Q1: 60.0% vs. Q3: 31.0%; P = 0.004). There were no differences across quartiles for frequency of level-2 hypoglycemia events and lipid profile (LDL-cholesterol and non-HDL-cholesterol). CONCLUSIONS Low-carbohydrate intakes are associated with higher probabilities of reaching HbA1c target and of never having experienced level-3 hypoglycemia. No associations with level-2 hypoglycemia frequency, nor cardiovascular risk factors were observed.
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Affiliation(s)
- Élisabeth Nguyen
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, Quebec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chem. De La Côte-Sainte-Catherine, Montreal, Quebec, H3T 1A8, Canada.
| | - Kayla Wong
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, Quebec, H2W 1R7, Canada; School of Human Nutrition, McGill University, 21111 Lakeshore Dr., Sainte-Anne-de-Bellevue, Quebec, H9X 2V9, Canada.
| | - Marie-Laure Lalanne-Mistrih
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, Quebec, H2W 1R7, Canada; Department of Nutrition, "UTDN-CSO", University Hospital of Guadeloupe, Rte de Chauvel, Les Abymes, Guadeloupe, France; Faculty of Medicine, University of Antilles, 6FQ8+39G, Pointe-à-Pitre, Guadeloupe, France.
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, Quebec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chem. De La Côte-Sainte-Catherine, Montreal, Quebec, H3T 1A8, Canada; Department of Endocrinology, University of Montreal Health Center, 1051 Rue Sanguinet, Montréal, Quebec, H2X 3E4, Canada; Montreal Diabetes Research Centre, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada.
| | - Anne-Sophie Brazeau
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, Quebec, H2W 1R7, Canada; School of Human Nutrition, McGill University, 21111 Lakeshore Dr., Sainte-Anne-de-Bellevue, Quebec, H9X 2V9, Canada; Montreal Diabetes Research Centre, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada.
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2
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Mitsutome E, Yanagi S, Uchida T, Horiguchi T, Tsubouchi H, Sumiyoshi M, Kitamura A, Oda Y, Ueno H, Yamaguchi H, Miyazaki T. Postprandial hypoglycemia caused by the combination of clarithromycin and rifampicin in a patient with nontuberculous mycobacterial pulmonary disease. J Infect Chemother 2024:S1341-321X(24)00207-1. [PMID: 39097170 DOI: 10.1016/j.jiac.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
Most cases of nontuberculous mycobacterial pulmonary disease (NTM-PD) have a progressive clinical course, and initiation of treatment is recommended rather than watchful waiting. The NTM-PD medications are frequently associated with adverse reactions, occasionally serious. Optimization of the methods for monitoring and managing adverse events in NTM-PD treatment is thus an important medical issue. Here we report a first case of postprandial hypoglycemia caused by the combination of clarithromycin (CAM) and rifampicin (RFP) in a patient with NTM-PD. A 73-year-old Japanese woman with NTM-PD was hospitalized for treatment with a combination of oral CAM, RFP, and ethambutol. She took the first doses of antibiotics before breakfast, and 3 h later went into a hypoglycemic state. Postprandial hypoglycemia occurred with high reproducibility and was accompanied by relative insulin excess. Continuous glucose monitoring with or without food and in combination with various patterns of medication revealed that the combination of CAM and RFP specifically induced postprandial hypoglycemia. Shifting the timing of administration of the CAM and RFP combination from morning to before sleep corrected the hypoglycemia and enabled continuation of the antimicrobial treatment. In conclusion, our report suggests the importance of introducing NTM-PD medication under inpatient management in order to closely monitor and early detect postprandial hypoglycemia and other serious adverse events.
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Affiliation(s)
- Eriko Mitsutome
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shigehisa Yanagi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Taisuke Uchida
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takanori Horiguchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hironobu Tsubouchi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Makoto Sumiyoshi
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Akiko Kitamura
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yasuharu Oda
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Ueno
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideki Yamaguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
| | - Taiga Miyazaki
- Division of Respirology Rheumatology Infectious Diseases and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 889-1692, Japan
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3
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Wang L, Bai Y, Cao Z, Guo Z, Lian Y, Liu P, Zeng Y, Lyu W, Chen Q. Histone deacetylases and inhibitors in diabetes mellitus and its complications. Biomed Pharmacother 2024; 177:117010. [PMID: 38941890 DOI: 10.1016/j.biopha.2024.117010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia, with its prevalence linked to both genetic predisposition and environmental factors. Epigenetic modifications, particularly through histone deacetylases (HDACs), have been recognized for their significant influence on DM pathogenesis. This review focuses on the classification of HDACs, their role in DM and its complications, and the potential therapeutic applications of HDAC inhibitors. HDACs, which modulate gene expression without altering DNA sequences, are categorized into four classes with distinct functions and tissue specificity. HDAC inhibitors (HDACi) have shown efficacy in various diseases, including DM, by targeting these enzymes. The review highlights how HDACs regulate β-cell function, insulin sensitivity, and hepatic gluconeogenesis in DM, as well as their impact on diabetic cardiomyopathy, nephropathy, and retinopathy. Finally, we suggest that targeted histone modification is expected to become a key method for the treatment of diabetes and its complications. The study of HDACi offers insights into new treatment strategies for DM and its associated complications.
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Affiliation(s)
- Li Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Yuning Bai
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Zhengmin Cao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Ziwei Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China
| | - Yanjie Lian
- Department of Cardiovascular Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, PR China
| | - Pan Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China
| | - Yixian Zeng
- Department of Proctology, Beibei Hospital of Traditional Chinese Medicine, Chongqing 400799, PR China
| | - Wenliang Lyu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, PR China.
| | - Qiu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province 610072, PR China.
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Ortiz-Zúñiga A, Amigó J, Sánchez M, Abad M, Simó R, Hernández C, Simó-Servat O. Impact in real-world of intermittent-scanned continuous glucose monitoring with alarms on hypoglycemia and its recognition in type 1 diabetes. Diabetes Res Clin Pract 2024; 214:111786. [PMID: 39029746 DOI: 10.1016/j.diabres.2024.111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Recent studies have demonstrated that real-time CGM use reduce the incidence severe hypoglycemic events and impaired awareness of hypoglycemia (IAH) However, there are few real-world studies evaluating the effect of intermittently scanned continuous glucose monitoring (isCGM) on hypoglycemic episodes and hypoglycemia unawareness (IAH). The present study was designed to cover this research-practice gap. METHODS This is a real-world, observational, prospective cohort study with 2 years of follow-up in which 60 subjects with T1D who experienced frequent hypoglycemic events were included. All the patients were invited to use isCGM type Abbott FreeStyle Libre 2® on a continuous basis for 2 years. Glucometric parameters were obtained during the initial 2 weeks using isCGM and compared with data collected for the same period at 1 year and at the end of follow-up. The IAH was evaluated using the Clarke questionnaire, and to assess psychological aspects related to hypoglycemia the Hypoglycemia Fear Survey (HFS) was used. RESULTS After 2-years of follow-up using isCGM, we observed a decrease in glucose variability (40.3 ± 0.8 % vs. 37.1 ± 0.9 %, p = 0.003), time in low glucose range (54-69 mg/dL) (5.2 ± 0.4 % vs. 3.6 ± 0.3 %, p = 0.001), time in very low glucose range (<54 mg/dL) (3.2 ± 0.5 % vs. 0.8 ± 0.2 %, p < 0.001), less events related to low glucose levels (10.6 ± 1.1 vs 8.0 ± 1.0, p = 0.042) and a short duration of hypoglycemia episodes (106.1 ± 5.9 min vs. 85.7 ± 5.7 min, p = 0.008). In addition, participants presented a reduction of 47 % in the frequency of IAH, assessed by the Clarke questionnaire scores (24.6 % vs. 11.6 %, p = 0.034), as well as hypoglycemia fear (77.8 ± 2.4 vs 68.2 ± 2.1, p < 0.001). Furthermore, a reduction in total insulin dose was also observed (0.64 ± 0.30 UI/Kg/day vs 0.56 ± 0.11 UI/Kg/day, p = 0.018). CONCLUSIONS In the real-world, long-term use of isCGM could reduce both hypoglycemic episodes and IAH in people with T1D.
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Affiliation(s)
- A Ortiz-Zúñiga
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - J Amigó
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - M Sánchez
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain.
| | - M Abad
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain.
| | - R Simó
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - C Hernández
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
| | - O Simó-Servat
- Endocrinology and Nutrition Department, Vall d'Hebron Hospital Campus, Barcelona 08035, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute and CIBERDEM (ISCIII), Barcelona 08035, Spain.
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5
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Dualib PM, Dib SA, Augusto GA, Truzzi AC, de Paula MA, Réa RR. Effect of switching from twice-daily basal insulin to once-daily insulin glargine 300 U/mL (Gla-300) in Brazilian people with type 1 diabetes. Diabetol Metab Syndr 2024; 16:152. [PMID: 38982528 PMCID: PMC11232174 DOI: 10.1186/s13098-024-01385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Low adherence to the number of insulin injections and glycemic variability are among the challenges of insulin therapy in type 1 diabetes (T1D). The TOP1 study investigated the effect of switching from twice-daily (BID) basal insulin to once daily (OD) insulin glargine 300 U/mL (Gla-300) on glycemic control and quality of life. METHODS In this 28-week, phase 4 trial, people with T1D aged ≥ 18 years, who were treated with BID basal insulin in combination with prandial rapid-acting insulin for at least 1 year, and had HbA1c between 7.5% and 10.0%, were switched to Gla-300 OD as basal insulin. The present study aimed to evaluate the impact of this change on HbA1c, glycemic profile, treatment satisfaction and safety. The change in HbA1c from baseline to Week 24 was the primary endpoint. RESULTS One hundred and twenty-three people with T1D (mean age 37 ± 11 years; 54.5% female) were studied. The disease duration was 20.0 ± 9.8 years, baseline HbA1c and fasting plasma glucose (FPG) were 8.6 ± 0.7% and 201 ± 80.3 mg/dL, respectively. After switching from BID to OD insulin regimen, no significant change in HbA1c was observed from baseline to Week 24 (p = 0.873). There were significant reductions in fasting self-monitoring blood glucose (SMBG) from baseline to Week 24 (175 ± 42 vs. 156 ± 38 mg/dL; p < 0.0001), and in glycemic profile (8-point SMBG) at several time points. There was a significant decrease in the proportion of patients with at least one hypoglycemic event (p = 0.025), in numbers of hypoglycemic events per patient-years of any type (p = 0.036), symptomatic (p = 0.007), and confirmed ≤ 70 mg/dL events (p = 0.049) from run-in to the last 4 weeks on treatment. There were significant improvements in treatment satisfaction (p < 0.0001), perceived hyperglycemia (p < 0.0001) scores and satisfaction with the number of injections between post-run-in and Week 24, and a significant decrease in fear of hypoglycemia. CONCLUSIONS Switch from BID basal insulin to OD Gla-300 as part of basal bolus therapy in T1D resulted in similar glycemic control as measured by HbA1c, but provided significant improvements in SMBG, daily glucose profile, a lower incidence of hypoglycemia and increased patient satisfaction. TRIAL REGISTRATION NCT03406000.
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Affiliation(s)
- Patricia Medici Dualib
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil.
- Diabetes Center of the Endocrinology Division, Paulista School of Medicine - Federal University of São Paulo, Rua Estado de Israel 639, São Paulo, 04022-001, SP, Brazil.
| | - Sergio Atala Dib
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, Brazil
| | | | | | | | - Rosângela Roginski Réa
- Serviço de Endocrinologia (SEMPR) do Hospital das Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil
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Bilal A, Yi F, Whitaker K, Igudesman D, Pratley R, Casu A. Impaired Awareness of Hypoglycemia in Older Adults With Type 1 Diabetes: A Post Hoc Analysis of the WISDM Study. Diabetes Care 2024; 47:1202-1210. [PMID: 38713913 DOI: 10.2337/dc24-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Up to one-third of older adults with type 1 diabetes experience impaired awareness of hypoglycemia (IAH), yet the factors associated with IAH remain underexplored in older adults. RESEARCH DESIGN AND METHODS This post hoc analysis evaluated the clinical and glycemic correlates of IAH in adults ≥60 years old with type 1 diabetes in the WISDM study. IAH and normal awareness of hypoglycemia (NAH) were defined by a Clarke score of ≥4 or <4, respectively. Demographic, clinical, and glycemic metrics were compared in those with IAH and NAH at baseline and in whom IAH did or did not improve over 26 weeks, using descriptive statistics and a multiple logistic regression variable selection procedure. RESULTS Of the 199 participants (age 68.1 ± 5.7 years, 52% female), 30.6% had IAH. At baseline, participants with IAH had a longer diabetes duration and greater daytime hypoglycemia and glycemic variability, and more participants had nondetectable C-peptide levels than those with NAH. Logistic regression associated longer diabetes duration (odds ratio [OR] 1.03, 95% CI 1.01-1.05; P = 0.008) and greater daytime hypoglycemia (OR 1.31, 95% CI, 1.15-1.51; P < 0.0001) with a greater odds of IAH. A similar modeling procedure identified less daytime hypoglycemia (OR per additional percentage point 0.55, 95% CI 0.32-0.94; P = 0.029) and shorter diabetes duration (OR per additional year 0.96, 95% CI 0.91-1.004; P = 0.07) as predictors of restored awareness at 26 weeks, although the effect size for diabetes duration was not statistically significant. CONCLUSIONS In older adults with type 1 diabetes, longer diabetes duration and greater daytime hypoglycemia are drivers of IAH. Dedicated research can personalize IAH management.
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Affiliation(s)
- Anika Bilal
- Translational Research Institute, AdventHealth, Orlando, FL
| | - Fanchao Yi
- Translational Research Institute, AdventHealth, Orlando, FL
| | - Keri Whitaker
- Translational Research Institute, AdventHealth, Orlando, FL
| | | | - Richard Pratley
- Translational Research Institute, AdventHealth, Orlando, FL
- AdventHealth Diabetes Institute, Orlando, FL
| | - Anna Casu
- Translational Research Institute, AdventHealth, Orlando, FL
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Scheuer SH, Andersen GS, Carstensen B, Diaz L, Kosjerina V, Lindekilde N, Wild SH, Jackson CA, Pouwer F, Benros ME, Jørgensen ME. Trends in Incidence of Hospitalization for Hypoglycemia and Diabetic Ketoacidosis in Individuals With Type 1 or Type 2 Diabetes With and Without Severe Mental Illness in Denmark From 1996 to 2020: A Nationwide Study. Diabetes Care 2024; 47:1065-1073. [PMID: 38640020 DOI: 10.2337/dc23-2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To examine trends in incidence of acute diabetes complications in individuals with type 1 or type 2 diabetes with and without severe mental illness (SMI) in Denmark by age and calendar year. RESEARCH DESIGN AND METHODS We conducted a cohort study using nationwide registers from 1996 to 2020 to identify individuals with diabetes, ascertain SMI status (namely, schizophrenia, bipolar disorder, or major depression) and identify the outcomes: hospitalization for hypoglycemia and diabetic ketoacidosis (DKA). We used Poisson regression to estimate incidence rates (IRs) and incidence rate ratios (IRRs) of recurrent hypoglycemia and DKA events by SMI, age, and calendar year, accounting for sex, diabetes duration, education, and country of origin. RESULTS Among 433,609 individuals with diabetes, 8% had SMI. Risk of (first and subsequent) hypoglycemia events was higher for individuals with SMI than for those without SMI (for first hypoglycemia event, IRR: type 1 diabetes, 1.77 [95% CI 1.56-2.00]; type 2 diabetes, 1.64 [95% CI 1.55-1.74]). Individuals with schizophrenia were particularly at risk for recurrent hypoglycemia events. The risk of first DKA event was higher in individuals with SMI (for first DKA event, IRR: type 1 diabetes, 1.78 [95% CI 1.50-2.11]; type 2 diabetes, 1.85 [95% CI 1.64-2.09]). Except for DKA in the type 2 diabetes group, IR differences between individuals with and without SMI were highest in younger individuals (<50 years old) but stable across the calendar year. CONCLUSIONS SMI is an important risk factor for acute diabetes complication and effective prevention is needed in this population, especially among the younger population and those with schizophrenia.
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Affiliation(s)
| | | | | | - Lars Diaz
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Vanja Kosjerina
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Nanna Lindekilde
- Department of Occupational & Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michael E Benros
- Copenhagen Research Centre for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Brøsen JMB, Bomholt T, Borg R, Persson F, Pedersen-Bjergaard U. Hyperglycaemia in people with diabetes and chronic kidney disease. Ugeskr Laeger 2024; 186:V01240051. [PMID: 38808757 DOI: 10.61409/v01240051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Assessment and treatment of hyperglycaemia in people with diabetes and chronic kidney disease (CKD) are challenging. In advanced CKD HbA1c can be unreliable, and treatment adjustments should be supported by other glucose measurements (e.g., continuous glucose monitoring (CGM) or blood glucose measurements). Glucose-lowering treatments should be evaluated based on CKD and an individualised assessment of risk factors especially hypoglycaemia. This review aims at providing an overview of the options for glycaemic monitoring and glucose-lowering treatments in people with diabetes and CKD.
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Affiliation(s)
- Julie Maria Bøggild Brøsen
- Endokrinologisk og Nefrologisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital - Hillerød
| | - Tobias Bomholt
- Nefrologisk Afdeling, Københavns Universitetshospital - Rigshospitalet
| | - Rikke Borg
- Medicinsk Afdeling, Sjællands Universitetshospital, Roskilde
- Institut for Klinisk Medicin, SUND, Københavns Universitet
| | | | - Ulrik Pedersen-Bjergaard
- Endokrinologisk og Nefrologisk Afdeling, Københavns Universitetshospital - Nordsjællands Hospital - Hillerød
- Institut for Klinisk Medicin, SUND, Københavns Universitet
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Kann O. Lactate as a supplemental fuel for synaptic transmission and neuronal network oscillations: Potentials and limitations. J Neurochem 2024; 168:608-631. [PMID: 37309602 DOI: 10.1111/jnc.15867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
Lactate shuttled from the blood circulation, astrocytes, oligodendrocytes or even activated microglia (resident macrophages) to neurons has been hypothesized to represent a major source of pyruvate compared to what is normally produced endogenously by neuronal glucose metabolism. However, the role of lactate oxidation in fueling neuronal signaling associated with complex cortex function, such as perception, motor activity, and memory formation, is widely unclear. This issue has been experimentally addressed using electrophysiology in hippocampal slice preparations (ex vivo) that permit the induction of different neural network activation states by electrical stimulation, optogenetic tools or receptor ligand application. Collectively, these studies suggest that lactate in the absence of glucose (lactate only) impairs gamma (30-70 Hz) and theta-gamma oscillations, which feature high energy demand revealed by the cerebral metabolic rate of oxygen (CMRO2, set to 100%). The impairment comprises oscillation attenuation or moderate neural bursts (excitation-inhibition imbalance). The bursting is suppressed by elevating the glucose fraction in energy substrate supply. By contrast, lactate can retain certain electric stimulus-induced neural population responses and intermittent sharp wave-ripple activity that features lower energy expenditure (CMRO2 of about 65%). Lactate utilization increases the oxygen consumption by about 9% during sharp wave-ripples reflecting enhanced adenosine-5'-triphosphate (ATP) synthesis by oxidative phosphorylation in mitochondria. Moreover, lactate attenuates neurotransmission in glutamatergic pyramidal cells and fast-spiking, γ-aminobutyric acid (GABA)ergic interneurons by reducing neurotransmitter release from presynaptic terminals. By contrast, the generation and propagation of action potentials in the axon is regular. In conclusion, lactate is less effective than glucose and potentially detrimental during neural network rhythms featuring high energetic costs, likely through the lack of some obligatory ATP synthesis by aerobic glycolysis at excitatory and inhibitory synapses. High lactate/glucose ratios might contribute to central fatigue, cognitive impairment, and epileptic seizures partially seen, for instance, during exhaustive physical exercise, hypoglycemia and neuroinflammation.
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Affiliation(s)
- Oliver Kann
- Institute of Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany
- Interdisciplinary Center for Neurosciences (IZN), University of Heidelberg, Heidelberg, Germany
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Lee MH, Gooley J, Obeyesekere V, Lu J, Paldus B, Hendrieckx C, MacIsaac RJ, McAuley SA, Speight J, Vogrin S, Jenkins AJ, Holmes-Walker DJ, O'Neal DN, Ward GM. Hybrid Closed Loop in Adults With Type 1 Diabetes and Severely Impaired Hypoglycemia Awareness. J Diabetes Sci Technol 2024:19322968241245627. [PMID: 38613225 DOI: 10.1177/19322968241245627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Benefits of hybrid closed-loop (HCL) systems in a high-risk group with type 1 diabetes and impaired awareness of hypoglycemia (IAH) have not been well-explored. METHODS Adults with Edmonton HYPO scores ≥1047 were randomized to 26-weeks HCL (MiniMed™ 670G) vs standard therapy (multiple daily injections or insulin pump) without continuous glucose monitoring (CGM) (control). Primary outcome was percentage CGM time-in-range (TIR; 70-180 mg/dL) at 23 to 26 weeks post-randomization. Major secondary endpoints included magnitude of change in counter-regulatory hormones and autonomic symptom responses to hypoglycemia at 26-weeks post-randomization. A post hoc analysis evaluated glycemia risk index (GRI) comparing HCL with control groups at 26 weeks post-randomization. RESULTS Nine participants (median [interquartile range (IQR)] age 51 [41, 59] years; 44% male; enrolment HYPO score 1183 [1058, 1308]; Clarke score 6 [6, 6]; n = 5 [HCL]; n = 4 [control]) completed the study. Time-in-range was higher using HCL vs control (70% [68, 74%] vs 48% [44, 50%], P = .014). Time <70 mg/dL did not differ (HCL 3.8% [2.7, 3.9] vs control 6.5% [4.3, 8.6], P = .14) although hypoglycemia episode duration was shorter (30 vs 50 minutes, P < .001) with HCL. Glycemia risk index was lower with HCL vs control (38.1 [30.0, 39.2] vs 70.8 [58.5, 72.4], P = .014). Following 6 months of HCL use, greater dopamine (24.0 [12.3, 27.6] vs -18.5 [-36.5, -4.8], P = .014), and growth hormone (6.3 [4.6, 16.8] vs 0.5 [-0.8, 3.0], P = .050) responses to hypoglycemia were observed. CONCLUSIONS Six months of HCL use in high-risk adults with severe IAH increased glucose TIR and improved GRI without increased hypoglycemia, and partially restored counter-regulatory responses. CLINICAL TRIAL REGISTRATION ACTRN12617000520336.
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Affiliation(s)
- Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Judith Gooley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Varuni Obeyesekere
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Jean Lu
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbora Paldus
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology & Diabetes, The Alfred, Melbourne, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Alicia J Jenkins
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Department of Endocrinology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Clinical Biochemistry, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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11
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Her QL, Dejene SZ, Ismail S, Wang T, Jonsson-Funk M, Pate V, Min JY, Flory J. Validation of an international classification of disease, tenth revision, clinical modification (ICD-10-CM) algorithm in identifying severe hypoglycaemia events for real-world studies. Diabetes Obes Metab 2024; 26:1282-1290. [PMID: 38204417 DOI: 10.1111/dom.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Abstract
AIM The transition to the ICD-10-CM coding system has reduced the utility of hypoglycaemia algorithms based on ICD-9-CM diagnosis codes in real-world studies of antidiabetic drugs. We mapped a validated ICD-9-CM hypoglycaemia algorithm to ICD-10-CM codes to create an ICD-10-CM hypoglycaemia algorithm and assessed its performance in identifying severe hypoglycaemia. MATERIALS AND METHODS We assembled a cohort of Medicare patients with DM and linked electronic health record (EHR) data to the University of North Carolina Health System and identified candidate severe hypoglycaemia events from their Medicare claims using the ICD-10-CM hypoglycaemia algorithm. We confirmed severe hypoglycaemia by EHR review and computed a positive predictive value (PPV) of the algorithm to assess its performance. We refined the algorithm by removing poor performing codes (PPV ≤0.5) and computed a Cohen's κ statistic to evaluate the agreement of the EHR reviews. RESULTS The algorithm identified 642 candidate severe hypoglycaemia events, and we confirmed 455 as true severe hypoglycaemia events, PPV of 0.709 (95% confidence interval: 0.672, 0.744). When we refined the algorithm, the PPV increased to 0.893 (0.862, 0.918) and missed <2.42% (<11) true severe hypoglycaemia events. Agreement between reviewers was high, κ = 0.93 (0.89, 0.97). CONCLUSIONS We translated an ICD-9-CM hypoglycaemia algorithm to an ICD-10-CM version and found its performance was modest. The performance of the algorithm improved by removing poor performing codes at the trade-off of missing very few severe hypoglycaemia events. The algorithm has the potential to be used to identify severe hypoglycaemia in real-world studies of antidiabetic drugs.
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Affiliation(s)
- Qoua L Her
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sara Z Dejene
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sherin Ismail
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michele Jonsson-Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Virigina Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jea Young Min
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - James Flory
- Endocrinology Service, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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12
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Dharma JFM, Polmear C, Fourlanos S, Kyi M. Reporting hypoglycaemia as a hospital-acquired complication: assessing biochemical and clinical validity. Intern Med J 2024; 54:430-437. [PMID: 37183584 DOI: 10.1111/imj.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND AIMS Given treatment-related hypoglycaemia in hospitals can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as a reportable hospital-acquired complication (HAC) with financial disincentives. However, the designation of a hypoglycaemia HAC relies on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of a hypoglycaemia HAC. METHODS We performed a retrospective review on patients discharged from the Northern Health hospitals between March and August 2021 who were designated as experiencing a hypoglycaemia HAC. We assessed cases for biochemical validity (glucose <4.0 mmol), clinical context and whether they were treatment-related (treatment with insulin or sulphonylurea). We then compared this cohort with a hospital-wide glucometric survey based on a point-prevalence study to determine the proportion of individuals with hypoglycaemic events that were designated as hypoglycaemia HAC. RESULTS Two hundred fifty-six admissions were coded as hypoglycaemia HAC. Eleven (4%) did not have a biochemically valid episode. Of the valid cases, 34 (14%) were not treated with any glucose-lowering medication and 11 (4%) were treated with noninsulin, nonsulphonylurea glucose-lowering medication. Two hundred admissions (78%) were considered treatment-related HAC. Of 139 individuals with diabetes identified in the hospital-wide point-prevalence study, 25 (18%) had biochemical evidence for hypoglycaemia: 22 were treatment-related, of which 68% were not coded as HAC. CONCLUSION Given safety and cost implications, the designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care.
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Affiliation(s)
- Joanna F M Dharma
- Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christine Polmear
- Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), University of Melbourne, Parkville, Victoria, Australia
| | - Mervyn Kyi
- Department of Endocrinology and Diabetes, Northern Health, Epping, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), University of Melbourne, Parkville, Victoria, Australia
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13
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Deshpande S, Weinzimer SA, Gibbons K, Nally LM, Weyman K, Carria L, Zgorski M, Laffel LM, Doyle FJ, Dassau E. Feasibility and Preliminary Safety of Smartphone-Based Automated Insulin Delivery in Adolescents and Children With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:363-371. [PMID: 35971681 PMCID: PMC10973844 DOI: 10.1177/19322968221116384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A smartphone-based automated insulin delivery (AID) controller device can facilitate use of interoperable components and acceptance in adolescents and children. METHODS Pediatric participants (N = 20, 8F) with type 1 diabetes were enrolled in three sequential age-based cohorts: adolescents (12-<18 years, n = 8, 5F), school-age (8-<12 years, n = 7, 2F), and young children (2-<8 years, n = 5, 1F). Participants used the interoperable artificial pancreas system (iAPS) and zone model predictive control (MPC) on an unlocked smartphone for 48 hours, consumed unrestricted meals of their choice, and engaged in various unannounced exercises. Primary outcomes and stopping criteria were defined using fingerstick blood glucose (BG) data; secondary outcomes compared continuous glucose monitoring (CGM) data with preceding sensor augmented pump (SAP) therapy. RESULTS During AID, there was no more than one BG <50 mg/dL except in one young child participant; no instance of more than two episodes of BG ≥300 mg/dL lasting longer than 2 hours; and no adverse events. Despite large meals (total of 404.9 grams of carbs) and unannounced exercise (total of 182 minutes), overall CGM percent time in range (TIR) of 70 to 180 mg/dL during AID was statistically similar to SAP (63.5% vs 57.3%, respectively, P = .145). Overnight glucose standard deviation was 43 mg/dL (vs SAP 57.9 mg/dL, P = .009) and coefficient of variation was 25.7% (vs SAP 34.9%, P < .001). The percent time in closed-loop mode and connected to the CGM was 92.7% and 99.6%, respectively. Surveys indicated that participants and parents/guardians were satisfied with the system. CONCLUSIONS The smartphone-based AID was feasible and safe in sequentially younger cohorts of adolescents and children. CLINICALTRIALS.GOV NCT04255381 (https://clinicaltrials.gov/ct2/show/NCT04255381).
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Affiliation(s)
- Sunil Deshpande
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | | | - Kate Weyman
- Yale University School of Medicine, New Haven, CT, USA
| | - Lori Carria
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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14
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Benhamou PY, Adenis A, Tourki Y, Pou S, Madrolle S, Franc S, Kariyawasam D, Beltrand J, Klonoff DC, Charpentier G. Efficacy of a Hybrid Closed-Loop Solution in Patients With Excessive Time in Hypoglycaemia: A Post Hoc Analysis of Trials With DBLG1 System. J Diabetes Sci Technol 2024; 18:372-379. [PMID: 36172702 PMCID: PMC10973855 DOI: 10.1177/19322968221128565] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Automated insulin delivery is an efficient treatment for patients with type 1 diabetes. Little is known on its impact on patients with excessive time in hypoglycaemia. METHODS We performed a post hoc analysis of three randomized control trials that used the DBLG1 (Diabeloop Generation 1) hybrid closed-loop solution. Patients whose time below 70 mg/dL during baseline, open-loop phase exceeded 5% were selected. The outcomes were the differences between the closed-loop and the open-loop phases in time in various ranges and Glycemia Risk Index (GRI). RESULTS We identified 45 patients exhibiting ≥5% of time below 70 mg/dL during the open-loop phase. Under closed-loop, the time in hypoglycaemia (54 to <70 mg/dL) dropped from 7.9% (SD 2.4) to 3.2% (SD 1.6) (difference -4.7% [-5.3; -4.1], P < 10-4). The time below 54 mg/dL decreased from 1.9% (SD 1.3) to 0.8% (SD 0.7) (difference -0.9% [-1.4; -0.8], P < 10-4). The time in range (TIR 70-180 mg/dL) improved from 63.3 (SD 9.5) to 68.2% (SD 8.2) (difference 5.1% [2.9; 7.0], P < 10-4). The GRI improved from 51.2 (SD 12.4) to 38.0 (SD 10.9) (difference 13.2 [10.4; 16.0], P < 10-4). CONCLUSION DBLG1 decreased time in hypoglycaemia by more than 50% even in patients with excessive time in hypoglycaemia at baseline, while also improving both TIR and GRI, under real-life conditions. The improvement in GRI (13.2%) exceeded that of the improvement in TIR (5.1%) indicating that in this data set, GRI was more sensitive than TIR to the improvement in glycaemia achieved with closed-loop. These results support the safety and efficacy of this treatment.
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Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospita, INSERM U1055, Laboratory of Fundamental and Applied Bioenergetics, Grenoble Alpes University, Grenoble, France
- Department of Endocrinology, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes
| | | | | | | | | | - Sylvia Franc
- Center for Study and Research for Improvement of the Treatment of Diabetes, Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| | - Dulanjalee Kariyawasam
- Department of Paediatric Endocrinology, Diabetology and Gynaecology, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris-Centre, Paris, France
- Paris Cite University, Paris, France
| | - Jacques Beltrand
- Department of Paediatric Endocrinology, Diabetology and Gynaecology, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris-Centre, Paris, France
- Paris Cite University, Paris, France
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Guillaume Charpentier
- Center for Study and Research for Improvement of the Treatment of Diabetes, Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
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15
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Li C, Ma Y, Chai X, Feng X, Feng W, Zhao Y, Cui C, Wang J, Zhao S, Zhu X. Ketogenic diet attenuates cognitive dysfunctions induced by hypoglycemia via inhibiting endoplasmic reticulum stress-dependent pathways. Food Funct 2024; 15:1294-1309. [PMID: 38197246 DOI: 10.1039/d3fo04007k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Hypoglycemia can potentially cause severe damage to the central nervous system. The ketogenic diet (KD), characterized by high-fat and extremely low-carbohydrate content, can modulate homeostasis and nutrient metabolism, thereby influencing body health. However, the effects and underlying mechanisms of KD on hypoglycemia-induced brain injury have not been thoroughly investigated. We aimed to explore the modulating effects of KD on cognitive functions and elucidate the underlying mechanisms. In this study, one-month-old mice were fed with KD for 2 weeks, and the changes in the gut microbiota were detected using the 16S rRNA gene amplicon sequencing method. The hypoglycemic model of mice was established using insulin, and the potential protective effect of KD on hypoglycemia-induced brain injury in mice was evaluated through immunofluorescence staining, western blotting, transmission electron microscopy, and Golgi staining. Our results showed that the intestinal flora of Dorea increased and Rikenella decreased in KD-fed mice. KD can not only alleviate anxiety-like behavior induced by hypoglycemia, but also increase the proportion of mushroom dendritic spines in the hippocampus by modulating changes in the gut microbiota. KD regulated synaptic plasticity by increasing the levels of SPN, PSD95, and SYP, which relieve cognitive impairment caused by hypoglycemia. Moreover, KD can promote the proliferation and survival of adult neural stem cells in the hippocampus, while reducing apoptosis by suppressing the activation of the IRE1-XBP1 and ATF6 endoplasmic reticulum stress pathways in mice with hypoglycemia. This study provides new evidence for demonstrating that KD may alleviate cognitive dysfunctions caused by hypoglycemia by modulating the gut microbiota.
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Affiliation(s)
- Cixia Li
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
- College of Life Science and Technology, Xinxiang Medical University, Xinxiang, Henan 453003, PR China
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, Henan 453003, PR China
| | - Yue Ma
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Xuejun Chai
- College of Basic Medicine, Xi'An Medical University, Xi'An, Shaanxi 710021, PR China
| | - Xiao Feng
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Wenyu Feng
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Yongkang Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Chaochu Cui
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, Henan 453003, PR China
| | - Jianguo Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Shanting Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
| | - Xiaoyan Zhu
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi 712100, PR China.
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16
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Mark-Wagstaff C, Deshmukh H, Wilmot EG, Walker N, Barnes D, Parfitt V, Saunders S, Gregory R, Choudhary P, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit. Diabetes Obes Metab 2024; 26:46-53. [PMID: 37718554 DOI: 10.1111/dom.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
AIM Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third-party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. METHODS The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web-based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow-up data for people with type 1 diabetes who also held a driving licence was undertaken. RESULTS The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow-up data were available for a sub-cohort of 1606/4218. At a mean follow-up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p < .001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p < .001). CONCLUSION This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode.
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Affiliation(s)
| | - Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust, Hull, UK
- University of Hull, Hull, UK
| | - Emma G Wilmot
- University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Neil Walker
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Dennis Barnes
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | | | | | - Rob Gregory
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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17
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Chen S, Lu J, Peng D, Liu F, Lu W, Zhu W, Bao Y, Zhou J, Jia W. Incidence rate and risk factors for hypoglycemia among individuals with type 1 diabetes or type 2 diabetes in China receiving insulin treatment. Diabetes Res Clin Pract 2023; 206:110987. [PMID: 37925076 DOI: 10.1016/j.diabres.2023.110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
AIMS We investigated the real-world incidence of hypoglycemic events among patients with type 1 or type 2 diabetes (T1DM or T2DM) receiving insulin in routine clinical practice in China. METHODS In this observational study, data were collected electronically via the Lilly Connected Care Program (LCCP) electronic system from adults with T1DM or T2DM who had registered on LCCP between 1 February 2019 and 31 January 2022, had used insulin for a full 12-week period following registration. The following outcomes were assessed during the 12 weeks following registration: incidence of level 1 and level 2 hypoglycemia. RESULTS In total, 22,752 patients were enrolled. Among patients with monitoring data, over the 12-week study period, level 1 and 2 hypoglycemia were experienced by 48.8% and 25.9% of patients with T1DM and 26.5% and 13.9% of patients with T2DM. The proportion of patients treated with oral anti-diabetes drugs (OADs) capable of producing hypoglycemia (sulfonylurea or glinide) was 1.3% in T1DM and 1.6% in T2DM, respectively. Questionnaire data revealed that up to 92.5% of hypoglycemic events occurred outside of hospital and 18.6% were serious. CONCLUSIONS These real-world data collected from Chinese patients with diabetes receiving insulin treatment reveal a relatively high percentage of patients experiencing hypoglycemia, with around one quarter of these events classified as severe and as many as 92.5% occurring outside of a hospital or clinic.
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Affiliation(s)
- Si Chen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Danfeng Peng
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Fengjing Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China.
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Ratzki-Leewing A, Black JE, Kahkoska AR, Ryan BL, Zou G, Klar N, Timcevska K, Harris SB. Severe (level 3) hypoglycaemia occurrence in a real-world cohort of adults with type 1 or 2 diabetes mellitus (iNPHORM, United States). Diabetes Obes Metab 2023; 25:3736-3747. [PMID: 37700692 PMCID: PMC10958739 DOI: 10.1111/dom.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
AIMS Among adults with insulin- and/or secretagogue-treated diabetes in the United States, very little is known about the real-world descriptive epidemiology of iatrogenic severe (level 3) hypoglycaemia. Addressing this gap, we collected primary, longitudinal data to quantify the absolute frequency of events as well as incidence rates and proportions. MATERIALS AND METHODS iNPHORM is a US-wide, 12-month ambidirectional panel survey (2020-2021). Adults with type 1 diabetes mellitus (T1DM) or insulin- and/or secretagogue-treated type 2 diabetes mellitus (T2DM) were recruited from a probability-based internet panel. Participants completing ≥1 follow-up questionnaire(s) were analysed. RESULTS Among 978 respondents [T1DM 17%; mean age 51 (SD 14.3) years; male: 49.6%], 63% of level 3 events were treated outside the health care system (e.g. by family/friend/colleague), and <5% required hospitalization. Following the 12-month prospective period, one-third of individuals reported ≥1 event(s) [T1DM 44.2% (95% CI 36.8%-51.8%); T2DM 30.8% (95% CI 28.7%-35.1%), p = .0404, α = 0.0007]; and the incidence rate was 5.01 (95% CI 4.15-6.05) events per person-year (EPPY) [T1DM 3.57 (95% CI 2.49-5.11) EPPY; T2DM 5.29 (95% CI 4.26-6.57) EPPY, p = .1352, α = 0.0007]. Level 3 hypoglycaemia requiring non-transport emergency medical services was more common in T2DM than T1DM (p < .0001, α = 0.0016). In total, >90% of events were experienced by <15% of participants. CONCLUSIONS iNPHORM is one of the first long-term, prospective US-based investigations on level 3 hypoglycaemia epidemiology. Our results underscore the importance of participant-reported data to ascertain its burden. Events were alarmingly frequent, irrespective of diabetes type, and concentrated in a small subsample.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jason E. Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine/Division of Endocrinology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Chambers ME, Nuibe EH, Reno-Bernstein CM. Brain Regulation of Cardiac Function during Hypoglycemia. Metabolites 2023; 13:1089. [PMID: 37887414 PMCID: PMC10608630 DOI: 10.3390/metabo13101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Hypoglycemia occurs frequently in people with type 1 and type 2 diabetes. Hypoglycemia activates the counter-regulatory response. Besides peripheral glucose sensors located in the pancreas, mouth, gastrointestinal tract, portal vein, and carotid body, many brain regions also contain glucose-sensing neurons that detect this fall in glucose. The autonomic nervous system innervates the heart, and during hypoglycemia, can cause many changes. Clinical and animal studies have revealed changes in electrocardiograms during hypoglycemia. Cardiac repolarization defects (QTc prolongation) occur during moderate levels of hypoglycemia. When hypoglycemia is severe, it can be fatal. Cardiac arrhythmias are thought to be the major mediator of sudden death due to severe hypoglycemia. Both the sympathetic and parasympathetic nervous systems of the brain have been implicated in regulating these arrhythmias. Besides cardiac arrhythmias, hypoglycemia can have profound changes in the heart and most of these changes are exacerbated in the setting of diabetes. A better understanding of how the brain regulates cardiac changes during hypoglycemia will allow for better therapeutic intervention to prevent cardiovascular death associated with hypoglycemia in people with diabetes. The aim of this paper is to provide a narrative review of what is known in the field regarding how the brain regulates the heart during hypoglycemia.
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Affiliation(s)
| | | | - Candace M. Reno-Bernstein
- Division of Endocrinology, Metabolism, and Diabetes, University of Utah School of Medicine, Salt Lake City, UT 84112, USA (E.H.N.)
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20
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González-Saldivar G, González-González JG, Chow DR, Mohamed-Hamsho J, González-Cortés JH, Sánchez-García A, Rodríguez-Gutiérrez R. Retinal Microvascular Density and Perfusion during an Insulin-Induced Hypoglycemia Episode: A Warning Call. Int J Clin Pract 2023; 2023:9928582. [PMID: 37876724 PMCID: PMC10593551 DOI: 10.1155/2023/9928582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
Aim To evaluate retinal vascular perfusion and density by optical coherence tomography angiography (OCTA) before, during, and after hypoglycemia in individuals with diabetes mellitus with or without diabetic retinopathy (DR). Methods A focused clinical history was performed, followed by an ophthalmological examination to document retinopathy status. OCTA was performed at baseline, at hypoglycemia, and at glucose normalization. Eye tracking and eye alignment devices on the platform were used to obtain a macular thickness cube (512 × 128) and vascular perfusion and density protocols of 3 × 3 mm. Retinal vascular reactivity was analyzed with superficial plexus vascular perfusion and density protocols on OCTA. Results Fifty-two participants encompassing 97 eyes fulfilled the eligibility criteria. Their mean age was 42.9 ± 15.1 years (range, 22 to 65), and 20 (38.2%) were men. We found a statistically significant difference in vascular perfusion and density when comparing all groups at baseline. The controls had higher vascular perfusion and density values than the cases. Vascular perfusion and density were significantly reduced in all groups during the hypoglycemia episode, except for vascular density in DR cases. Conclusion Acute hypoglycemia significantly alters the retinal vascularity in DM patients with and without DR, suggesting that repeated episodes of acute hypoglycemia could exacerbate retinopathy in the long term.
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Affiliation(s)
- Gerardo González-Saldivar
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - José Gerardo González-González
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - David Robert Chow
- Department of Ophthalmology, St. Michael's Hospital, Toronto, ON, Canada
| | - Jesús Mohamed-Hamsho
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - Jesús Hernan González-Cortés
- Department of Ophthalmology, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - Adriana Sánchez-García
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
| | - René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Calle Dr. Eduardo Aguirre Pequeño s/n, Sotano Edificio CRIDS, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario “Dr. Jose E. González”, Universidad Autónoma de Nuevo León, Av. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
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Ratzki-Leewing AA, Black JE, Ryan BL, Zou G, Klar N, Webster-Bogaert S, Timcevska K, Harris SB. Development and validation of a real-world model to predict 1-year Level 3 (severe) hypoglycaemia risk in adults with diabetes (the iNPHORM study, United States). Diabetes Obes Metab 2023; 25:2910-2927. [PMID: 37409569 DOI: 10.1111/dom.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/21/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
AIMS We aimed to develop and internally validate a real-world prognostic model for Level 3 hypoglycaemia risk compatible with outpatient care in the United States. MATERIALS AND METHODS iNPHORM is a 12-month, US-based panel survey. Adults (18-90 years old) with type 1 diabetes mellitus or insulin- and/or secretagogue-treated type 2 diabetes mellitus were recruited from a nationwide, probability-based internet panel. Among participants completing ≥ 1 follow-up questionnaire(s), we modelled 1-year Level 3 hypoglycaemia risk using Andersen and Gill's Cox survival and penalized regression with multiple imputation. Candidate variables were selected for their clinical relevance and ease of capture at point-of-care. RESULTS In total, 986 participants [type 1 diabetes mellitus: 17%; men: 49.6%; mean age: 51 (SD: 14.3) years] were analysed. Across follow-up, 035.1 (95% CI: 32.2-38.1)% reported ≥1 Level 3 event(s), and the rate was 5.0 (95% CI: 4.1-6.0) events per person-year. Our final model showed strong discriminative validity and parsimony (optimism corrected c-statistic: 0.77). Numerous variables were selected: age; sex; body mass index; marital status; level of education; insurance coverage; race; ethnicity; food insecurity; diabetes type; glycated haemoglobin value; glycated haemoglobin variability; number, type and dose of various medications; number of SH events requiring hospital care (past year and over follow-up); type and number of comorbidities and complications; number of diabetes-related health care visits (past year); use of continuous/flash glucose monitoring; and general health status. CONCLUSIONS iNPHORM is the first US-based primary prognostic study on Level 3 hypoglycaemia. Future model implementation could potentiate risk-tailored strategies that reduce real-world event occurrence and overall diabetes burden.
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Affiliation(s)
- Alexandria A Ratzki-Leewing
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jason E Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Robarts Research Institute, Western University, London, Canada
| | - Neil Klar
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Susan Webster-Bogaert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kristina Timcevska
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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22
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Li M, Zhao M, Yan H, Guo H, Shi B. Clinical characteristics and influencing factors of hypoglycemia in hospitalized patients with type 2 diabetes mellitus: A cross-sectional study. Nurs Open 2023; 10:6827-6835. [PMID: 37452509 PMCID: PMC10495719 DOI: 10.1002/nop2.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
AIM Analysed clinical characteristics and influencing factors for hypoglycemia in hospitalized patients with type 2 diabetes mellitus (T2DM), and providing a scientific reference for precision nursing care of hypoglycemia in hospitalized patients with T2DM. DESIGN A cross-sectional study. METHODS This study involved 378 hospitalized patients diagnosed with T2DM who have suffered hypoglycemia. Through questionnaires and electronic medical records to obtain the data concerning the general information, clinical symptoms, all recorded blood glucose information, and the diabetes knowledge and self-management level of the patients. The clinical characteristics and influencing factors for hypoglycemia were analysed on the basis of the classification of hypoglycemia published by the American Diabetes Association in 2020. RESULTS Among 378 patients, 207 patients (54.76%) were experiencing Grade 1 hypoglycemia and 171 patients (45.24%) were experiencing Grade 2 hypoglycemia. Hypoglycemia and Grade 2 hypoglycemia in patients with T2DM occurred predominantly within the first 3 days of hospitalization. Hypoglycemia occurred most frequently after breakfast (74 cases, 19.6%), of which Grade 1 hypoglycemia and Grade 2 hypoglycemia accounted for 50%, respectively. Multivariable logistic regression identified risk factors for Grade 2 hypoglycemia in hospitalized patients with type 2 diabetes: older age, longer duration of diabetes, low body weight, diabetic nephropathy stages 4-5, diabetic autonomic neuropathy, inadequate self-management ability and diabetes knowledge, and lower educational background. CONCLUSIONS Hypoglycemia in type 2 diabetes occurs in the first 3 days during the hospitalization and most often after breakfast during the full day. Identifying high-risk individuals and providing a scientific reference for precision nursing care of hypoglycemia in hospitalized patients with T2DM.
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Affiliation(s)
- Meng Li
- Department of EndocrinologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Meng Zhao
- Department of EndocrinologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Huan Yan
- Department of Internal Science, Medical Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Hui Guo
- Department of EndocrinologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Bingyin Shi
- Department of EndocrinologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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23
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Song SH, Frier BM. Severe hypoglycaemia in adults presenting to a hospital emergency department: Clinical characteristics, comorbidities, and mortality outcomes. Diabetes Obes Metab 2023; 25:2824-2834. [PMID: 37334521 DOI: 10.1111/dom.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
AIMS To determine the clinical characteristics, risk factors and mortality outcomes associated with severe hypoglycaemia (SH) treated at a hospital emergency department. MATERIALS AND METHODS Adult patients presenting with SH to the Northern General Hospital, Sheffield, UK over a 44-month period were assessed for clinical characteristics, coexisting comorbidities and mortality outcomes, including cause of death, and analysed by age of diabetes onset, below and above age 40 years. Factors that predicted mortality were determined. RESULTS A total of 619 episodes of SH occurred in 506 individuals. Most had type 1 (T1D; n = 172 [34.0%]) or type 2 diabetes (T2D; n = 216 [42.7%]), but several attendees did not have diabetes (non-DM; n = 110 [21.7%]). Irrespective of age of diabetes onset, patients with T2D had more socioeconomic deprivation and comorbidities (P < 0.005). SH was uncommon in those with young-onset T2D, who constituted 7.2% of all episodes in diabetes. Hospital admission was high (60%-75%). The T2D cohort had the longest inpatient stay (median 5 days, vs. 2 and 3 days for the T1D and non-DM cohorts, respectively). Survival after the index SH episode was lower and mortality was higher in the non-DM (39.1%) and T2D (38.0%) cohorts than the T1D cohort (13.3%; all P < 0.05), with a median time to death of 13, 113 and 465 days, respectively. Most deaths (78%-86%) were from non-cardiovascular causes. Charlson index predicted mortality and poor survival in T1D and T2D (both P < 0.05). CONCLUSIONS Severe hypoglycaemia requiring emergency hospital treatment is associated with non-cardiovascular deaths and exerts a disproportionately greater impact on mortality in people with T2D and those without diabetes. Multimorbidity is an important risk factor for SH and increases mortality risk.
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Affiliation(s)
- Soon H Song
- Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Brian M Frier
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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24
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Søholm U, Zaremba N, Broadley M, Axelsen JL, Divilly P, Martine-Edith G, Amiel SA, Mader JK, Pedersen-Bjergaard U, McCrimmon RJ, Renard E, Evans M, de Galan B, Heller S, Hendrieckx C, Choudhary P, Speight J, Pouwer F. Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study. JMIR Diabetes 2023; 8:e42100. [PMID: 37773626 PMCID: PMC10576226 DOI: 10.2196/42100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The Hypoglycaemia - MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. OBJECTIVE The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. METHODS Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. RESULTS A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. CONCLUSIONS The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual's daily functioning. Despite suggested improvements, participants' responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact.
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Affiliation(s)
- Uffe Søholm
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Natalie Zaremba
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Patrick Divilly
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Gilberte Martine-Edith
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Montpellier, France
| | - Mark Evans
- Welcome-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Centre, Maastricht, Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Christel Hendrieckx
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Australia
| | - Pratik Choudhary
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Australia
- Steno Diabetes Center Odense, Odense, Denmark
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25
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Chang A, Chang A, Chen WT, Chan L, Hong CT, Chien LN. Triple therapy for Helicobacter pylori eradication and the risk of hypoglycemia in patients with diabetes: a population-based cohort study. BMC Public Health 2023; 23:1772. [PMID: 37700268 PMCID: PMC10496377 DOI: 10.1186/s12889-023-16689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
The incidence of type 2 diabetes mellitus has risen globally, from 108 million cases in 1980 to 422 million cases in 2014. Although controlling glycemic levels in patients with diabetes is crucial, insulin and sulfonylureas can cause hypoglycemic episodes and even potentially fatal events such as comas, seizures, life-threatening arrhythmias, and myocardial infarctions. Several antibiotics have been documented to cause hypoglycemic episodes; the use of antibiotics along with insulin or sulfonylureas might further increase the risk of hypoglycemia. Therefore, researchers must determine which antibiotics carry a risk of inducing severe hypoglycemic events. The prevalence of H. pylori infection remains high in most countries, and the infection is often treated with triple therapy involving amoxicillin, clarithromycin, and a proton pump inhibitor (PPI). Several case reports have reported that hypoglycemia can occur when used with patients who also take diabetes medication. Therefore, we hypothesized that patients with diabetes have an increased risk of hypoglycemic episodes when being treated with triple therapy for H. pylori infection. By analyzing medical records from Taiwan's National Health Insurance Research Database, we found a significant association between hypoglycemia and triple therapy treatment for diabetic patients with peptic ulcer disease. Prescribing triple therapy to patients with diabetes and peptic ulcers significantly increased the risk of a hypoglycemic episode (adjusted odds ratio [aOR] = 1.75, 95% confidence interval [CI]: 1.64 to 1.88, P < 0.001). Similarly, the highest aOR (5.77, 95% CI 4.82 to 6.92) was found in patients with diabetes and peptic ulcers who had hypoglycemic episodes within 30 days after triple therapy treatment. Many patients with diabetes require H.pylori eradication for peptic ulcer treatment, and vigilance toward the risk of hypoglycemia in this population is thus necessary.
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Affiliation(s)
- Anne Chang
- Department of Endocrinology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Anna Chang
- Department of Neurology, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei, Taiwan
| | - Wan-Ting Chen
- Health Data Analytics and Statistics Center, Taipei Medical University, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Li-Nien Chien
- Institution of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.
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Sun DK, Zhang N, Liu Y, Qiu JC, Tse G, Li GP, Roever L, Liu T. Dysglycemia and arrhythmias. World J Diabetes 2023; 14:1163-1177. [PMID: 37664481 PMCID: PMC10473954 DOI: 10.4239/wjd.v14.i8.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
Disorders in glucose metabolism can be divided into three separate but interrelated domains, namely hyperglycemia, hypoglycemia, and glycemic variability. Intensive glycemic control in patients with diabetes might increase the risk of hypoglycemic incidents and glucose fluctuations. These three dysglycemic states occur not only amongst patients with diabetes, but are frequently present in other clinical settings, such as during critically ill. A growing body of evidence has focused on the relationships between these dysglycemic domains with cardiac arrhythmias, including supraventricular arrhythmias (primarily atrial fibrillation), ventricular arrhythmias (malignant ventricular arrhythmias and QT interval prolongation), and bradyarrhythmias (bradycardia and heart block). Different mechanisms by which these dysglycemic states might provoke cardiac arr-hythmias have been identified in experimental studies. A customized glycemic control strategy to minimize the risk of hyperglycemia, hypoglycemia and glucose variability is of the utmost importance in order to mitigate the risk of cardiac arrhythmias.
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Affiliation(s)
- Dong-Kun Sun
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Ying Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jiu-Chun Qiu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Kent and Medway Medical School, Kent CT2 7NT, Canterbury, United Kingdom
- School of Nursing and Health Studies, Metropolitan University, Hong Kong 999077, China
| | - Guang-Ping Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, 38400384, MG, Brazil
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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Alsharif AA, Wong ICK, Ma T, Lau W, Alhamed M, Alwafi H, Wei L. The association between dementia and the risk of hypoglycaemia events among patients with diabetes mellitus: a propensity-score matched cohort analysis. Front Med (Lausanne) 2023; 10:1177636. [PMID: 37476614 PMCID: PMC10354255 DOI: 10.3389/fmed.2023.1177636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background Hypoglycaemia commonly occurs in patients diagnosed with diabetes mellitus (DM) and dementia. The impact of dementia on hypoglycaemic events is controversial. Thus, we evaluated whether dementia increases the risk of hypoglycaemic events in older patients diagnosed with DM. Design A retrospective cohort study. Setting We used the IQVIA Medical Research Data (IMRD-UK) database (formerly known as the THIN database). Participants All patients aged ≥55 years and diagnosed with DM who were prescribed at least two prescriptions of antidiabetic medication between 2000 and 2017. Two groups of patients, dementia and non-dementia group, were propensity-score (PS) matched at 1:2. The risk of hypoglycaemia was assessed through a Cox regression analysis. Main outcome and measures Hypoglycaemic events were determined during the follow-up period by Read codes. Results From the database, 133,664 diabetic patients were identified, with a mean follow-up of 6.11 years. During the study period, 7,762 diabetic patients diagnosed with dementia were matched with 12,944 diabetic patients who had not been diagnosed with dementia. The PS-matched Cox regression analysis showed that patients diagnosed with dementia were at a 2-fold increased risk for hypoglycaemic events compared with those not diagnosed with dementia (hazard ratio [HR], 2.00; 95% CI, 1.63-2.66). A similar result was shown for a multivariable analysis using all patient data (adjusted HR, 2.25; 95% CI, 2.22-2.32). Conclusion Our findings suggest that diabetic patients with a diagnosis of dementia have a statistically significant higher risk of experiencing hypoglycaemia.
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Affiliation(s)
- Alaa A. Alsharif
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Ian C. K. Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Tian Ma
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Wallis Lau
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Meshari Alhamed
- Department of Emergency Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
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Zhang X, Qiao X, Peng K, Gao S, Hao Y. Digital Behavior Change Interventions to Reduce Sedentary Behavior and Promote Physical Activity in Adults with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Behav Med 2023:10.1007/s12529-023-10188-9. [PMID: 37391571 DOI: 10.1007/s12529-023-10188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Technological advancements and ease of Internet access have increased the number of digital behavior change interventions (DBCIs). This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in reducing sedentary behavior (SB) and promoting physical activity (PA) in adults with diabetes. METHODS A comprehensive search of seven databases-PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, and Sedentary Behavior Research Database-was performed. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. Meta-analyses were performed where feasible; otherwise, narrative summaries were performed. RESULTS A total of 13 randomized controlled trials with 980 participants met the inclusion criteria. Overall, DBCIs could significantly increase steps and the number of breaks in sedentary time. The subgroup analyses exhibited significant effects in DBCIs with over 10 behavior change techniques (BCTs) in improving steps, the time spent in light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The subgroup analyses showed a significant step increment in DBCIs of moderate and long durations, with over 4 BCT clusters, or in conjunction with a face-to-face component. The subgroup analyses also indicated significant effects in studies with ≥ 2 DBCI components in improving steps, the time spent in LPA and MVPA, and reducing sedentary time. CONCLUSION There is some evidence that DBCI may increase PA and reduce SB in adults with type 2 diabetes. However, more high-quality studies are required. Future studies are needed to examine the potential of DBCIs in adults with type 1 diabetes.
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Affiliation(s)
- Xiaoyan Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization of the Registered Nurses' Association of Ontario, Beijing, China
- Beijing University of Chinese Medicine Centre for Evidence-Based Nursing: A JBI Affiliated Group, Beijing, China
| | - Xue Qiao
- Beijing University of Chinese Medicine Best Practice Spotlight Organization of the Registered Nurses' Association of Ontario, Beijing, China
- Beijing University of Chinese Medicine Centre for Evidence-Based Nursing: A JBI Affiliated Group, Beijing, China
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Ke Peng
- Department of Nursing, Beijing Hospital, Beijing, China
| | - Shan Gao
- Outpatient Department, Chinese PLA General Hospital, Beijing, China
| | - Yufang Hao
- Beijing University of Chinese Medicine Best Practice Spotlight Organization of the Registered Nurses' Association of Ontario, Beijing, China.
- Beijing University of Chinese Medicine Centre for Evidence-Based Nursing: A JBI Affiliated Group, Beijing, China.
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
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Black JE, Harris SB, Ryan BL, Zou G, Ratzki-Leewing A. Real-World Effects of Second-Generation Versus Earlier Intermediate/Basal Insulin Analogues on Rates of Hypoglycemia in Adults with Type 1 and 2 Diabetes (iNPHORM, US). Diabetes Ther 2023:10.1007/s13300-023-01423-3. [PMID: 37270453 PMCID: PMC10299942 DOI: 10.1007/s13300-023-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Second-generation basal insulin analogues have been shown to reduce hypoglycemia in several trials and observational studies of select populations; however, it remains unclear whether these results persist in real-world settings. Using self-reported hypoglycemia events, we assessed whether second-generation basal insulin analogues reduce rates of hypoglycemia events (non-severe/severe; overall/daytime/nocturnal) compared to earlier intermediate/basal insulin analogues among people with insulin-treated type 1 or 2 diabetes. METHODS We used prospectively collected data from the Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-World Models (iNPHORM) panel survey. This US-wide, 1-year internet-based survey assessed hypoglycemia experiences and related sociodemographic and clinical characteristics of people with diabetes (February 2020-March 2021). We estimated population-average rate ratios for hypoglycemia comparing second-generation to earlier intermediate/basal insulin analogues using negative binomial regression, adjusting for confounders. Within-person variability of repeated observations was addressed with generalized estimating equations. RESULTS Among iNPHORM participants with complete data, N = 413 used an intermediate/basal insulin analogue for ≥ 1 month during follow-up. After adjusting for baseline and time-updated confounders, average second-generation basal insulin analogue users experienced a 19% (95% CI 3-32%, p = 0.02) lower rate of overall non-severe hypoglycemia and 43% (95% CI 26-56%, p < 0.001) a lower rate of nocturnal non-severe hypoglycemia compared to earlier intermediate/basal insulin users. Overall severe hypoglycemia rates were similar among second-generation and earlier intermediate/basal insulin users (p = 0.35); however, the rate of severe nocturnal hypoglycemia was reduced by 44% (95% CI 10-65%, p = 0.02) among second-generation insulin users compared to earlier intermediate/basal insulin users. CONCLUSION Our real-world results suggest second-generation basal insulin analogues reduce rates of hypoglycemia, especially nocturnal non-severe and severe events. Whenever possible and feasible, clinicians should prioritize prescribing these agents over first-generation basal or intermediate insulin in people with type 1 and 2 diabetes.
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Affiliation(s)
- Jason E Black
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | - Alexandria Ratzki-Leewing
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Christou MA, Christou PA, Kyriakopoulos C, Christou GA, Tigas S. Effects of Hypoglycemia on Cardiovascular Function in Patients with Diabetes. Int J Mol Sci 2023; 24:ijms24119357. [PMID: 37298308 DOI: 10.3390/ijms24119357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Hypoglycemia is common in patients with type 1 and type 2 diabetes (T1D, T2D), treated with insulin or sulfonylureas, and has multiple short- and long-term clinical implications. Whether acute or recurrent, hypoglycemia significantly affects the cardiovascular system with the potential to cause cardiovascular dysfunction. Several pathophysiological mechanisms have been proposed linking hypoglycemia to increased cardiovascular risk, including hemodynamic changes, myocardial ischemia, abnormal cardiac repolarization, cardiac arrhythmias, prothrombotic and proinflammatory effects, and induction of oxidative stress. Hypoglycemia-induced changes can promote the development of endothelial dysfunction, which is an early marker of atherosclerosis. Although data from clinical trials and real-world studies suggest an association between hypoglycemia and cardiovascular events in patients with diabetes, it remains uncertain whether this association is causal. New therapeutic agents for patients with T2D do not cause hypoglycemia and have cardioprotective benefits, whereas increasing the use of new technologies, such as continuous glucose monitoring devices and insulin pumps, has the potential to reduce hypoglycemia and its adverse cardiovascular outcomes in patients with T1D.
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Affiliation(s)
- Maria A Christou
- Department of Endocrinology, University of Ioannina Faculty of Medicine, 45500 Ioannina, Greece
| | - Panagiota A Christou
- Department of Endocrinology, University of Ioannina Faculty of Medicine, 45500 Ioannina, Greece
| | - Christos Kyriakopoulos
- Department of Respiratory Medicine, University of Ioannina Faculty of Medicine, 45500 Ioannina, Greece
| | - Georgios A Christou
- Laboratory of Physiology, University of Ioannina Faculty of Medicine, 45500 Ioannina, Greece
| | - Stelios Tigas
- Department of Endocrinology, University of Ioannina Faculty of Medicine, 45500 Ioannina, Greece
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Chien A, Thanasekaran S, Gaetano A, Im G, Wherry K, MacLeod J, Vigersky RA. Potential cost savings in the United States from a reduction in sensor-detected severe hypoglycemia among users of the InPen smart insulin pen system. J Manag Care Spec Pharm 2023; 29:285-292. [PMID: 36692907 PMCID: PMC10394220 DOI: 10.18553/jmcp.2023.22283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND: Severe hypoglycemia is a significant barrier to optimizing insulin therapy in both type 1 and type 2 diabetes and places a burden on the US health care system because of the high costs of hypoglycemia-related health care utilization. OBJECTIVE: To compare the frequency of sensor-detected severe hypoglycemic events (SHEs) among a population of continuous glucose monitoring (CGM) users on insulin therapy after initiation of the InPen smart insulin pen (SIP) system and to estimate the potential hypoglycemia-related medical cost savings across a population of SIP users. METHODS: SIP users of all ages with type 1 or type 2 diabetes were required to have at least 90 days of SIP use with a connected CGM device. The last 14 days of sensor glucose (SG) data within the 30-day period prior to the start of SIP use ("pre-SIP") and the last 14 days of SG data, along with the requirement of at least 1 bolus entry per day within the 61- to 90-day period after SIP start ("post-SIP"), were analyzed. Sensor-detected SHEs (defined as ≥10 minutes of consecutive SG readings at <54 mg/dL) were determined. Once factored, the expected medical intervention rates and associated costs were calculated. Intervention rates and costs were obtained from the literature. RESULTS: There were 1,681 SIP + CGM users from March 1, 2018, to April 30, 2021. The mean number of sensor-detected SHEs per week declined from 0.67 in the pre-SIP period to 0.58 in the post-SIP period (P = 0.008), which represented a 13% reduction. Assuming a range of 5%-25% of all sensor-detected SHEs resulted in a clinical event, the estimated cost reduction associated with reduced SHEs was $12-$59 and $110-$551 per SIP user per month and per year, respectively. For those aged at least 65 years, there were 166 SIP+CGM users and the reduction in the mean number of sensor-detected SHEs per week between the pre-SIP and post-SIP periods was 31%. CONCLUSIONS: Use of the SIP system with a connected CGM is associated with reduced sensor-detected severe hypoglycemia, which may result in significant cost savings. DISCLOSURES: Albert Chien, Glen Im, Kael Wherry, Janice MacLeod, and Robert A Vigersky are employees of Medtronic; Sneha Thanasekaran and Angela Gaetano were affiliated with Medtronic while doing this research. The submitted work did not involve study subject recruitment, enrollment, or participation in a trial and did not fall under human subject protection requirements (per the Department of Health and Human Services CFR Part 46) necessitating Internal Review Board approval or exemption.
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Affiliation(s)
| | | | | | - Glen Im
- Medtronic Diabetes, Northridge, CA
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Zhou C, Dong C, Xie Z, Hao W, Fu C, Sun H, Zhu D. Sex-specific associations between diabetes and dementia: the role of age at onset of disease, insulin use and complications. Biol Sex Differ 2023; 14:9. [PMID: 36804018 PMCID: PMC9940390 DOI: 10.1186/s13293-023-00491-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Whether the association of type 2 diabetes (T2DM) with dementia was differed by sex remains unclear, and the roles of age at onset of disease, insulin use and diabetes' complications in their association are unknown. METHODS This study analyzed data of 447 931 participants from the UK Biobank. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between T2DM and incident dementia [all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD)]. The roles of age at onset of disease, insulin use and diabetes' complications in their association were also analyzed. RESULTS Compared to people with no diabetes at all, people with T2DM had increased risk of all-cause dementia (HR 2.85, 95% CI 2.56-3.17). The HRs between T2DM and AD were higher in women than men, with an RHR (95%CI) of 1.56 (1.20, 2.02). There was a trend that people who experienced T2DM before age 55 had higher risk of VD than those who had T2DM after age 55. In addition, there was a trend that T2DM had higher effect on VD that occurred before age 75 years than events that occurred after age 75. Patients with T2DM using insulin had higher risk of all-cause dementia than those without insulin, with an RHR (95%CI) of 1.54 (1.00-2.37). People with complications had doubled risk of all-cause dementia, AD and VD. CONCLUSIONS Adopting a sex-sensitive strategy to address the risk of dementia in patients with T2DM is instrumental for a precision medicine approach. Meanwhile, it is warranted to consider patients' age at onset of T2DM, insulin use status and complications conditions.
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Affiliation(s)
- Chunmiao Zhou
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Caiyun Dong
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Ziwei Xie
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Wenting Hao
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, , Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
| | - Chunying Fu
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Huizi Sun
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
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Lehmann V, Zueger T, Maritsch M, Kraus M, Albrecht C, Bérubé C, Feuerriegel S, Wortmann F, Kowatsch T, Styger N, Lagger S, Laimer M, Fleisch E, Stettler C. Machine learning for non-invasive sensing of hypoglycaemia while driving in people with diabetes. Diabetes Obes Metab 2023; 25:1668-1676. [PMID: 36789962 DOI: 10.1111/dom.15021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
AIM To develop and evaluate the concept of a non-invasive machine learning (ML) approach for detecting hypoglycaemia based exclusively on combined driving (CAN) and eye tracking (ET) data. MATERIALS AND METHODS We first developed and tested our ML approach in pronounced hypoglycaemia, and then we applied it to mild hypoglycaemia to evaluate its early warning potential. For this, we conducted two consecutive, interventional studies in individuals with type 1 diabetes. In study 1 (n = 18), we collected CAN and ET data in a driving simulator during euglycaemia and pronounced hypoglycaemia (blood glucose [BG] 2.0-2.5 mmol L-1 ). In study 2 (n = 9), we collected CAN and ET data in the same simulator but in euglycaemia and mild hypoglycaemia (BG 3.0-3.5 mmol L-1 ). RESULTS Here, we show that our ML approach detects pronounced and mild hypoglycaemia with high accuracy (area under the receiver operating characteristics curve 0.88 ± 0.10 and 0.83 ± 0.11, respectively). CONCLUSIONS Our findings suggest that an ML approach based on CAN and ET data, exclusively, enables detection of hypoglycaemia while driving. This provides a promising concept for alternative and non-invasive detection of hypoglycaemia.
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Affiliation(s)
- Vera Lehmann
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Zueger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Maritsch
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Mathias Kraus
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- School of Business, Economics and Society, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Caroline Albrecht
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caterina Bérubé
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | | | - Felix Wortmann
- Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Naïma Styger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Lagger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elgar Fleisch
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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The Role of Platelets in Hypoglycemia-Induced Cardiovascular Disease: A Review of the Literature. Biomolecules 2023; 13:biom13020241. [PMID: 36830610 PMCID: PMC9953659 DOI: 10.3390/biom13020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally as well as the leading cause of mortality and morbidity in type 2 diabetes (T2D) patients. Results from large interventional studies have suggested hyperglycemia and poor glycemic control to be largely responsible for the development of CVDs. However, the association between hypoglycemia and cardiovascular events is also a key pathophysiological factor in the development of CVDs. Hypoglycemia is especially prevalent in T2D patients treated with oral sulfonylurea agents or exogenous insulin, increasing the susceptibility of this population to cardiovascular events. The adverse cardiovascular risk of hypoglycemia can persist even after the blood glucose levels have been normalized. Hypoglycemia may lead to vascular disease through mechanisms such as enhanced coagulation, oxidative stress, vascular inflammation, endothelial dysfunction, and platelet activation. In the following review, we summarize the evidence for the role of hypoglycemia in platelet activation and the subsequent effects this may have on the development of CVD. In addition, we review current evidence for the effectiveness of therapies in reducing the risk of CVDs.
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Heller S, Battelino T, Bailey TS, Pieber TR, Hövelmann U, Plum-Mörschel L, Melgaard AE, Aronson R, DiMeglio LA, Johansen T, Danne T. Integrated safety and efficacy analysis of dasiglucagon for the treatment of severe hypoglycaemia in individuals with type 1 diabetes. Diabetes Obes Metab 2023; 25:1351-1360. [PMID: 36692230 DOI: 10.1111/dom.14987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
AIMS To perform an integrated analysis of the safety and efficacy of dasiglucagon, a glucagon analogue available in a ready-to-use aqueous formulation, to treat severe hypoglycaemia (SH) in type 1 diabetes (T1D). MATERIALS AND METHODS An integrated analysis of dasiglucagon safety was conducted on data from two placebo-controlled trials (placebo-controlled pool) and two placebo-controlled and four non-placebo-controlled trials (broad pool) in adults with T1D. An integrated analysis of dasiglucagon efficacy was conducted of pooled data and within demographic subgroups from the two placebo-controlled and two non-placebo-controlled trials in adults with T1D. RESULTS Dasiglucagon had a similar safety and tolerability profile to that of reconstituted glucagon. In the placebo-controlled datasets, no serious adverse events (AEs), AEs leading to withdrawal from the trial, or deaths were reported. The most common causally related AEs were nausea (56.5%) and vomiting (24.6%). The broad pool safety analysis showed similar results. Dasiglucagon efficacy in time to plasma glucose recovery from insulin-induced SH was similar to that of reconstituted glucagon (median 10.0 and 12.0 minutes, respectively) and superior to placebo (median 40.0 minutes; P < 0.0001). The median recovery time was consistent across all placebo-controlled trial subgroups. CONCLUSIONS Dasiglucagon was well tolerated and effective as a rapid rescue agent for insulin-induced SH in people with T1D.
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Affiliation(s)
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | | | | | | | - Ronnie Aronson
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada
| | | | | | - Thomas Danne
- Children's Hospital AUF DER BULT, Hannover, Germany
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36
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Chen S, Qiang J, Zhang Y, Zhao B, Tian R, Yuan T, Li M, Li M, Li Y, Zhu H, Pan H. Hypoglycemia as a potential risk for patients taking clopidogrel: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1091933. [PMID: 36926026 PMCID: PMC10011644 DOI: 10.3389/fendo.2023.1091933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Clopidogrel is a cornerstone antiplatelet drug used in cardiovascular, cerebrovascular, and peripheral artery diseases. The sulfhydryl group of clopidogrel metabolite could induce insulin autoimmune syndrome (IAS) with hypoglycemia as the major symptom. Discontinuing clopidogrel and substituting it with ticagrelor has been revealed as an effective treatment in previous studies. Since hypoglycemia serves as a risk factor for cardiovascular and cerebrovascular events, we aimed to determine the association between hypoglycemia/IAS and clopidogrel and to investigate whether clopidogrel is a modifiable and causal risk factor of hypoglycemia/IAS. METHODS MEDLINE, Embase, Cochrane databases, and clinical trial registries were searched for randomized controlled trials (RCTs) of clopidogrel from inception to 28 February 2022. RCTs comparing clopidogrel with placebo or other antiplatelet drugs were eligible if meeting the inclusion criteria: 1) clopidogrel was administrated 75 mg qd orally as a long-term antiplatelet prescription at least for months, and 2) hypoglycemia-inducible drugs were not used in the control arm. One investigator abstracted articles and performed a quality assessment. Uncertainties were resolved by discussions with two investigators independently. Odds ratio (OR) and risk difference (RD) were calculated and performed with subgroup analyses. The pre-specified protocol was registered in PROSPERO (CRD42022299622). RESULTS Six trials with 61,399 participants in total fulfilled the criteria and were included in the meta-analysis. Clopidogrel might not be associated with higher hypoglycemia odds (OR 0.95, 95% CI 0.65 to 1.40). However, Asian participants (p = 0.0437) seemed more likely to develop clopidogrel-associated hypoglycemia. Clopidogrel-associated hypoglycemia occurred at the highest rate of 0.03% (RD -0.00023, 95% CI -0.00077 to 0.00031), and this increased to 0.91% (RD 0.00210, 95% CI -0.00494 to 0.00914) in an aging population and to 0.18% (RD 0.00040, 95% CI -0.00096 to 0.00177) when Asian ratio of the population was elevated. CONCLUSIONS We raise the concern that clopidogrel might be a modifiable and causal risk factor of hypoglycemia. The Asian population might be more vulnerable and need additional care. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero, identifier CRD42022299622.
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Affiliation(s)
- Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Qiang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Centre, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yuan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Hui Pan,
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Wu Y, Li R, Zhang Y, Long T, Zhang Q, Li M. Prediction Models for Prognosis of Hypoglycemia in Patients with Diabetes: A Systematic Review and Meta-Analysis. Biol Res Nurs 2023; 25:41-50. [PMID: 35839096 DOI: 10.1177/10998004221115856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically summarize the reported prediction models for hypoglycemia in patients with diabetes, compare their performance, and evaluate their applicability in clinical practice. METHODS We selected studies according to the PRISMA, appraised studies according to the Prediction model Risk of Bias Assessment Tool (PROBAST), and extracted and synthesized the data according to the CHARMS. The databases of PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to 31 October 2021 using a systematic review approach to capture all eligible studies developing and/or validating a prognostic prediction model for hypoglycemia in patients with diabetes. The risk bias and clinical applicability were assessed using the PROBAST. The meta-analysis of the performance of the prediction models were also conducted. The protocol of this study was recorded in PROSPERO (CRD42022309852). RESULTS Sixteen studies with 22 models met the eligible criteria. The predictors with the high frequency of occurrence among all models were age, HbA1c, history of hypoglycemia, and insulin use. A meta-analysis of C-statistic was performed for 21 prediction models, and the summary C-statistic and its 95% confidence interval and prediction interval were 0.7699 (0.7299-0.8098), 0.7699 (0.5862-0.9536), respectively. Heterogeneity exists between different hypoglycemia prediction models (τ2 was 0.00734≠0). CONCLUSIONS The existing predictive models are not recommended for widespread clinical use. A high-quality hypoglycemia screening tool should be developed in future studies.
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Affiliation(s)
- Yi Wu
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ruxue Li
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Yating Zhang
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Tianxue Long
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Qi Zhang
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Mingzi Li
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
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Demirbilek H, Vuralli D, Haris B, Hussain K. Managing Severe Hypoglycaemia in Patients with Diabetes: Current Challenges and Emerging Therapies. Diabetes Metab Syndr Obes 2023; 16:259-273. [PMID: 36760580 PMCID: PMC9888015 DOI: 10.2147/dmso.s313837] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
Hypoglycaemia is common in patients with diabetes mellitus and is a limiting factor for achieving adequate glycaemic control. In the vast majority of cases, hypoglycaemia develops due to the imbalance between food intake and insulin injections. As recurrent hypoglycaemia leads to significant morbidity and mortality, the recognition and immediate treatment of hypoglycaemia in diabetic patients is thus important. In the last 20 years, the introduction of improved insulin analogues, insulin pump therapy, continuous glucose monitoring (CGM), and sensor-augmented pump therapy have all made significant improvements in helping to reduce and prevent hypoglycaemia. In terms of treatment, the American Diabetes Association recommends oral glucose as the first-line treatment option for all conscious patients with hypoglycaemia. The second line of treatment (or first line in unconscious patients) is the use of glucagon. Novel formulations of glucagon include the nasal form, the Gvoke HypoPen which is a ready-to-deliver auto-injector packaged formulation and finally a glucagon analogue, Dasiglucagon. The Dasiglucagon formulation has recently been approved for the treatment of severe hypoglycaemia. It is a ready-to-use, similar to endogenous glucagon and its potency is also the same as native glucagon. It does not require reconstitution before injection and therefore ensures better compliance. Thus, significant improvements including development of newer insulin analogues, insulin pump therapy, continuous glucose monitoring (CGM), sensor-augmented pump therapy and novel formulations of glucagon have all contributed to reducing and preventing hypoglycaemia in diabetic individuals. However, considerable challenges remain as not all patients have access to diabetes technologies and to the newer glucagon formulations to help reduce and prevent hypoglycaemia.
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Affiliation(s)
- Huseyin Demirbilek
- Department of Pediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dogus Vuralli
- Department of Pediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Basma Haris
- Department of Pediatric Endocrinology, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Department of Pediatric Endocrinology, Sidra Medicine, Doha, Qatar
- Correspondence: Khalid Hussain, Sidra Medicine, OPC, C6-340, PO Box 26999, Al Luqta Street, Education City North Campus, Doha, Qatar, Tel +974-4003-7608, Email
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Okauchi S, Tatsumi F, Takahashi K, Katakura Y, Shimoda M, Kohara K, Kimura T, Obata A, Nakanishi S, Mune T, Kaku K, Kaneto H. Case report of severe hypoglycemic alcoholic ketoacidosis: A possible pitfall in diagnosis of ketoacidosis. Medicine (Baltimore) 2022; 101:e31996. [PMID: 36550800 PMCID: PMC9771289 DOI: 10.1097/md.0000000000031996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUNDS Hypoglycemic alcoholic ketoacidosis is known to be one of the emergent diseases but its frequency is very low compared to hyperglycemic ketoacidosis or hyperosmolar hyperglycemic syndrome observed in subjects with diabetes mellitus. CASE PRESENTATION We experienced a case who had alcoholic ketoacidosis and severe hypoglycemia after drinking too much alcohol without taking enough food for a long period of time. In this subject, plasma glucose level was as low as 25 mg/dL, and ketone bodies, especially 3-hydroxybutyrate, were markedly increased. In addition, in blood gas analysis, severe acidosis was observed and anion gap was increased. These points were compatible with hypoglycemia alcoholic ketoacidosis. CONCLUSIONS When we examine subjects with ketoacidosis and hypoglycemia, we should bear in mind the possibility of hypoglycemic alcoholic ketoacidosis especially in subjects who drink too much alcohol without taking enough food for a long period of time.
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Affiliation(s)
- Seizo Okauchi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Kaio Takahashi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Yukino Katakura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Kenji Kohara
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Shuhei Nakanishi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Kohei Kaku
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Matsushima, Kurashiki, Japan
- * Correspondence: Hideaki Kaneto, Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan (e-mail: )
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40
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Pauley ME, Tommerdahl KL, Snell-Bergeon JK, Forlenza GP. Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits. Curr Cardiol Rep 2022; 24:2043-2056. [PMID: 36279036 PMCID: PMC9589770 DOI: 10.1007/s11886-022-01799-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. This review will describe common diabetes devices and combination systems, as well as review relationships between device use and cardiovascular outcomes in T1D. RECENT FINDINGS Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality. CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends. Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D.
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Affiliation(s)
- Meghan E Pauley
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
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Applications of bile acids as biomaterials-based modulators, in biomedical science and microfluidics. Ther Deliv 2022; 13:591-604. [PMID: 36861306 DOI: 10.4155/tde-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Chronic disorders such as diabetes mellitus are associated with multiple organ dysfunction, including retinopathy, neuropathy, nephropathy, peripheral vascular disease, and vascular disease. Lifelong subcutaneous insulin injections are currently the only treatment option for patients with Type 1 diabetes mellitus, and it poses numerous challenges. Since the breakthrough achieved from the Edmonton protocol in the year 2000, there has been important research to investigate whether islet cell transplantation can achieve long-term normoglycemia in patients without the need for insulin. The use of biopolymeric scaffold to enclose islet cells has also been explored to improve survivability and viability of islet cells. This review paper summarizes the latest research in using biopolymeric scaffolds in islet transplantation and how microfluidic devices can assist.
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Alosaimi AM, Alsulaimani NH, Alotaibi WA. Potential mechanisms for poor glycaemic control in patients with type two diabetes and fear of hypoglycaemia. J Diabetes Metab Disord 2022; 21:1689-1697. [PMID: 36404853 PMCID: PMC9672273 DOI: 10.1007/s40200-022-01123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
Purpose The current study aimed to explore the potential effect of diabetes-related distress on the association between fear of hypoglycaemia and poor glycaemic control. We evaluated the specific aspects of fear of hypoglycaemia that affect glycaemic control among Saudi patients with type 2 diabetes (T2D). Methods Descriptive cross-sectional survey of patients with T2D attending a specialist diabetes clinic in Taif, Saudi Arabia. We used the Hypoglycaemia Attitudes and Behaviour Scale (HABS) for assessing fear of hypoglycaemia among our sample. We used Structural Equation Modelling to evaluate the moderators and correlates of fear of hypoglycaemia. Results We surveyed 365 patients with T2D. Cronbach's alpha for the HABS assessment was 0.84, an indication of excellent internal consistency. The composite reliability for hypoglycaemic anxiety was 86.8%; hypoglycaemic avoidance was 85.2%; and hypoglycaemic confidence was 92.6%. The mean HABS score was 32.7 points (out of 70 points; SD = 9.8 points). Fear of hypoglycaemia was associated with increased levels of glycated haemoglobin (HbA1c), presence of eye disease, heart disease, and stroke. Fear of hypoglycaemia was associated with poor glycaemic control. No significant moderating effect of diabetes-related distress was observed. However, only hypoglycaemic anxiety and avoidance were associated with poor glycaemic control. Confidence in the ability to control low glucose levels was not associated with elevated HbA1c levels. Conclusion A significant finding of this study highlighted the considerable and direct effect of fear of hypoglycaemia on poor glycaemic control among patients with T2D. However, only fear-related anxiety and avoidance-and not confidence in the ability to control low glucose levels-had an effect on poor glycaemic control.
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Ciudin A, Simó R. New methods for the diagnosis and monitoring of cognitive function in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13:1024794. [PMID: 36531450 PMCID: PMC9751391 DOI: 10.3389/fendo.2022.1024794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive impairment and later dementia), with a significant impact on the management of the disease and its complications. Therefore, it is recommended to perform an annual evaluation of cognitive function in patients with diabetes older than 65 years. Current guidelines still recommend the use of the Minimental State Evaluation Test (MMSE) as screening test, but it has a modest sensitivity and specificity for identifying mild cognitive impairment. This represents an important gap because patients with mild cognitive impairment are at risk of progressing to dementia. The neurocognitive diagnosis is based on complex neuropsychological tests, which require specifically trained personnel and are time consuming, making its routine incorporation into daily clinical practice unfeasible. Therefore, at present there are no reliable biomarkers to identify patients with type 2 diabetes at increased risk of developing cognitive impairment. Since the brain and the retina have a common embryological origin, our Research Group, has worked over the last 10 years evaluating the usefulness of the retina as a "window" to the brain. We provided evidence that retinal microperimetry is a simple, feasible and useful tool for screening and monitoring cognitive function in patients with type 2 diabetes. We propose a review of actual tests recommended for screening of cognitive impairment as well as an update of new emerging methods, such as retinal microperimetry.
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Affiliation(s)
- Andreea Ciudin
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autónoma de Barcelona, Department of Human Physiology and Inmunology, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autónoma de Barcelona, Department of Medicine, Barcelona, Spain
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Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
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Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
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Choice of Glucose-Lowering Drugs as Initial Monotherapy for Type 2 Diabetes Patients with Contraindications or Intolerance to Metformin: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11237094. [PMID: 36498669 PMCID: PMC9740076 DOI: 10.3390/jcm11237094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are multiple glucose-lowering drugs available as alternative initial monotherapy for type 2 diabetes patients with contraindications or intolerance to metformin. However, little comparative and systematic data are available for them as initial monotherapy. This study estimated and compared the treatment effects of glucose-lowering drugs as initial monotherapy for type 2 diabetes. METHODS PubMed, Web of Science, Embase, CNKI, Chongqing VIP, and WanFang Data from 1 January 1990 until 31 December 2020 were searched for randomized controlled trials which compared a glucose-lowering drug with placebo/lifestyle-intervention for type 2 diabetes. Drug classes included metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), glinides (NIDEs), α-glucosidase inhibitors (AGIs), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium-glucose cotransporter-2 inhibitors (SGLT2is), insulins (INSs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). RESULTS A total of 185 trials were included, identifying 38,376 patients from 56 countries across six continents. When choosing an initial drug monotherapy alternative to metformin, SUs were most efficacious in reducing HbA1c (-1.39%; 95% CI -1.63, -1.16) and FPG (-2.70 mmol/L; 95% CI -3.18, -2.23), but increased hypoglycemia risks (5.44; 95% CI 2.11, 14.02). GLP-1RAs were most efficacious in reducing BMI (-1.05 kg/m2; 95% CI -1.81, -0.29) and TC (-0.42 mmol/L; 95% CI -0.61, -0.22). TZDs were most efficacious in increasing HDL-C (0.12 mmol/L; 95% CI 0.07, 0.17). SGLT2is were most efficacious in lowering SBP (-4.18 mmHg; 95% CI -4.84, -3.53). While AGIs conferred higher risk of AE-induced discontinuations (2.57; 95% CI 1.64, 4.03). Overall, only GLP-1RAs showed an integrated beneficial effect on all outcomes. Our results also confirmed the intraclass differences in treatment effects across drugs. Most trials were short-term, and no significant differences in mortality, total vascular events, myocardial infarction, heart failure, stroke, or diabetic nephropathy were observed across drug classes. CONCLUSIONS Our results suggest a potential treatment hierarchy for decision-makers, with GLP-1RAs being the preferred alternative therapy to metformin regarding their favorable efficacy and safety profiles.
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Dib SA. Hypoglycemia in type 1 diabetes: a burden to worry about during treatment. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:776-779. [PMID: 36394481 PMCID: PMC10118773 DOI: 10.20945/2359-3997000000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia 2022; 65:1883-1894. [PMID: 35380233 PMCID: PMC9522821 DOI: 10.1007/s00125-022-05685-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Amit Shapira
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Lori Laffel
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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Schottelkotte KM, Crone SA. Forebrain control of breathing: Anatomy and potential functions. Front Neurol 2022; 13:1041887. [PMID: 36388186 PMCID: PMC9663927 DOI: 10.3389/fneur.2022.1041887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023] Open
Abstract
The forebrain plays important roles in many critical functions, including the control of breathing. We propose that the forebrain is important for ensuring that breathing matches current and anticipated behavioral, emotional, and physiological needs. This review will summarize anatomical and functional evidence implicating forebrain regions in the control of breathing. These regions include the cerebral cortex, extended amygdala, hippocampus, hypothalamus, and thalamus. We will also point out areas where additional research is needed to better understand the specific roles of forebrain regions in the control of breathing.
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Affiliation(s)
- Karl M. Schottelkotte
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Steven A. Crone
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States,Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States,*Correspondence: Steven A. Crone
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Verhulst CEM, Fabricius TW, Nefs G, Kessels RPC, Pouwer F, Teerenstra S, Tack CJ, Broadley MM, Kristensen PL, McCrimmon RJ, Heller S, Evans ML, Pedersen-Bjergaard U, de Galan BE. Consistent Effects of Hypoglycemia on Cognitive Function in People With or Without Diabetes. Diabetes Care 2022; 45:2103-2110. [PMID: 35876660 PMCID: PMC9472511 DOI: 10.2337/dc21-2502] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose level <3.0 mmol/L as "level 2 hypoglycemia." In the current study we investigated whether having diabetes, type of diabetes, or hypoglycemia awareness moderates this association. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 ± 0.13 mmol/L [50.2 ± 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP). RESULTS For the whole group, hypoglycemia decreased the mean ± SD proportion of correct answers on the PASAT by 8.4 ± 12.8%, increased reaction time on the TAP Alertness task by 32.1 ± 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 ± 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA1c. CONCLUSIONS IHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia <3.0 mmol/L (<54 mg/dL) as being clinically relevant for most people with diabetes.
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Affiliation(s)
- Clementine E M Verhulst
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Therese W Fabricius
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Diabeter, Rotterdam, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia.,Steno Diabetes Center Odense, Odense, Denmark
| | - Steven Teerenstra
- Biostatistics, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Melanie M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Peter L Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, U.K
| | - Mark L Evans
- Wellcome Trust/MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Hermanns N, Ehrmann D, Heinemann L, Freckmann G, Waldenmaier D, Calhoun P. Real-Time Continuous Glucose Monitoring Can Predict Severe Hypoglycemia in People with Type 1 Diabetes: Combined Analysis of the HypoDE and DIAMOND Trials. Diabetes Technol Ther 2022; 24:603-610. [PMID: 35604794 DOI: 10.1089/dia.2022.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: We combined data from two landmark trials (DIAMOND and HypoDE) to examine the diagnostic performance of low glucose measurements derived from open and masked continuous glucose monitoring (CGM) to predict the occurrence of future severe hypoglycemia (SH). Methods: We analyzed hypoglycemia parameters (low blood glucose index [LBGI], % <70 mg/dL, 54-69 mg/dL [level 1 hypoglycemia] and <54 mg/dL [level 2 hypoglycemia]) from masked CGM over 14 days during baseline and from open CGM over 14 days after randomization. We used receiver operating characteristics (ROC) curves to evaluate the screening performance of these measures to predict future SH. Positive likelihood ratios were calculated to indicate the overall diagnostic performance of these parameters. Results: Data from 288 individuals with type 1 diabetes (mean age 45.6 ± 12.8 years, diabetes duration 20.7 ± 13.7 years, HbA1c 8.2% ± 1.0%, Hypoglycemia Unawareness Score 3.4 ± 2.1) were analyzed. Area under ROC-curve (AUC) for LBGI and % <70 mg/dL ranged between 0.68 and 0.75, indicating that LBGI and % <70 mg/dL could significantly predict future SH. Significance of AUC regarding % <54 mg/dL were mixed (0.63-0.72). Positive and negative likelihood ratios ranged between 1.82 to 3.40 and 0.56 to 0.32, respectively. Suggested optimal cutoff values were remarkedly lower in open CGM than in masked CGM. Conclusion: These results indicate that CGM-derived hypoglycemic parameters have a good screening performance to significantly predict future clinical hypoglycemia. In addition, this analysis suggests that cutoff values to indicate elevated hypoglycemia risk in the future are substantially lower in open CGM than in masked CGM. ClinicalTrials.gov registration numbers: HypoDE: NCT02671968. DIAMOND: NCT02282397.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | | | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs-und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
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