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Mellor J, Kuznetsov D, Heller S, Gall MA, Rosilio M, Amiel SA, Ibberson M, McGurnaghan S, Blackbourn L, Berthon W, Salem A, Qu Y, McCrimmon RJ, de Galan BE, Pedersen-Bjergaard U, Leaviss J, McKeigue PM, Colhoun HM. Risk factors and prediction of hypoglycaemia using the Hypo-RESOLVE cohort: a secondary analysis of pooled data from insulin clinical trials. Diabetologia 2024; 67:1588-1601. [PMID: 38795153 PMCID: PMC11343909 DOI: 10.1007/s00125-024-06177-6] [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: 12/21/2023] [Accepted: 03/28/2024] [Indexed: 05/27/2024]
Abstract
AIMS/HYPOTHESIS The objective of the Hypoglycaemia REdefining SOLutions for better liVES (Hypo-RESOLVE) project is to use a dataset of pooled clinical trials across pharmaceutical and device companies in people with type 1 or type 2 diabetes to examine factors associated with incident hypoglycaemia events and to quantify the prediction of these events. METHODS Data from 90 trials with 46,254 participants were pooled. Analyses were done for type 1 and type 2 diabetes separately. Poisson mixed models, adjusted for age, sex, diabetes duration and trial identifier were fitted to assess the association of clinical variables with hypoglycaemia event counts. Tree-based gradient-boosting algorithms (XGBoost) were fitted using training data and their predictive performance in terms of area under the receiver operating characteristic curve (AUC) evaluated on test data. Baseline models including age, sex and diabetes duration were compared with models that further included a score of hypoglycaemia in the first 6 weeks from study entry, and full models that included further clinical variables. The relative predictive importance of each covariate was assessed using XGBoost's importance procedure. Prediction across the entire trial duration for each trial (mean of 34.8 weeks for type 1 diabetes and 25.3 weeks for type 2 diabetes) was assessed. RESULTS For both type 1 and type 2 diabetes, variables associated with more frequent hypoglycaemia included female sex, white ethnicity, longer diabetes duration, treatment with human as opposed to analogue-only insulin, higher glucose variability, higher score for hypoglycaemia across the 6 week baseline period, lower BP, lower lipid levels and treatment with psychoactive drugs. Prediction of any hypoglycaemia event of any severity was greater than prediction of hypoglycaemia requiring assistance (level 3 hypoglycaemia), for which events were sparser. For prediction of level 1 or worse hypoglycaemia during the whole follow-up period, the AUC was 0.835 (95% CI 0.826, 0.844) in type 1 diabetes and 0.840 (95% CI 0.831, 0.848) in type 2 diabetes. For level 3 hypoglycaemia, the AUC was lower at 0.689 (95% CI 0.667, 0.712) for type 1 diabetes and 0.705 (95% CI 0.662, 0.748) for type 2 diabetes. Compared with the baseline models, almost all the improvement in prediction could be captured by the individual's hypoglycaemia history, glucose variability and blood glucose over a 6 week baseline period. CONCLUSIONS/INTERPRETATION Although hypoglycaemia rates show large variation according to sociodemographic and clinical characteristics and treatment history, looking at a 6 week period of hypoglycaemia events and glucose measurements predicts future hypoglycaemia risk.
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Affiliation(s)
- Joseph Mellor
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | | | - Simon Heller
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Mari-Anne Gall
- Medical & Science, Insulin, Clinical Drug Development, Novo Nordisk A/S, Soeberg, Denmark
| | - Myriam Rosilio
- Eli Lilly and Company, Diabetes Medical Unit, Neuilly sur seine, France
| | - 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, UK
| | - Mark Ibberson
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Stuart McGurnaghan
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Luke Blackbourn
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - William Berthon
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Adel Salem
- RW Data Assets, AI & Analytics (AIA), Novo Nordisk A/S, Soeberg, Denmark
| | - Yongming Qu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Bastiaan E de Galan
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Yunir E, Nugraha ARA, Rosana M, Kurniawan J, Iswati E, Sarumpaet A, Tarigan TJE, Tahapary DL. Risk factors of severe hypoglycemia among patients with type 2 diabetes mellitus in outpatient clinic of tertiary hospital in Indonesia. Sci Rep 2023; 13:16259. [PMID: 37758787 PMCID: PMC10533826 DOI: 10.1038/s41598-023-43459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to describe risk factors of severe hypoglycemia in type 2 diabetes mellitus (T2DM) patients in a tertiary care hospital in Indonesia. This study was a retrospective cohort study in the Endocrinology Outpatient Clinic of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. All subjects more than 18 years old who had been visiting the clinic for at least a year were included. Subjects were interviewed whether they had any severe hypoglycemia events within the past year, while data on risk factor variables of severe hypoglycemia was taken from medical records one year before data collection. We recruited 291 subjects, among whom 25.4% suffered at least one episode of severe hypoglycemia within one year. History of severe hypoglycemia (OR 5.864, p ≤ 0.001), eGFR less than 60 mL/min/1.73m2 (OR 1.976, p = 0.028), and insulin use (OR 2.257, p = 0.021) were associated with increased risk of severe hypoglycemia. In conclusion, history of previous severe hypoglycemia, eGFR less than 60 mL/min/1.73m2, and insulin use were associated with severe hypoglycemia.
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Affiliation(s)
- Em Yunir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
- Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Antonius R A Nugraha
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Martha Rosana
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Clinical Epidemiological Unit, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Eni Iswati
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Angela Sarumpaet
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tri Juli Edi Tarigan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dicky L Tahapary
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Hughes AS, Chapman KS, Nguyen H, Liu J, Bispham J, Winget M, Weinzimer SA, Wolf WA. Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes. Clin Diabetes 2023; 41:399-410. [PMID: 37456102 PMCID: PMC10338275 DOI: 10.2337/cd22-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Severe hypoglycemia (SH) is the most frequent and potentially serious complication affecting individuals with type 1 diabetes and can have major clinical and psychosocial consequences. Glucagon is the only approved treatment for SH that can be administered by non-health care professionals (HCPs); however, reports on the experiences and emotions of people with type 1 diabetes associated with SH and glucagon rescue use are limited. This survey study demonstrated that an increasing number of individuals with type 1 diabetes have current and filled prescriptions for glucagon and have been educated about glucagon rescue use by an HCP. Despite this positive trend, challenges with SH remain, including a high level of health care resource utilization, considerable out-of-pocket expenses for glucagon kits, a high prevalence of hypoglycemia unawareness, and a negative emotional impact on individuals with diabetes. Nocturnal and exercise-related hypoglycemia were concerns for most survey participants.
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Affiliation(s)
- Allyson S. Hughes
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Hinahara J, Weinzimer SA, Bromley ER, Goss TF, Kendall DM, Hammer M. Dasiglucagon demonstrates reduced costs in the treatment of severe hypoglycemia in a budget impact model. J Manag Care Spec Pharm 2022; 28:461-472. [PMID: 35332789 PMCID: PMC10373001 DOI: 10.18553/jmcp.2022.28.4.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND: Approximately 7.3 million people with type 1 or type 2 diabetes (T1D/T2D) are treated with insulin, placing them at higher risk of severe hypoglycemia (SH). SH requires assistance of another individual and often necessitates the prompt administration of intravenous glucose, injectable glucagon, or both. Untreated, SH can progress to unconsciousness, seizures, coma, or death. Before 2018, all glucagon rescue treatments required reconstitution. The complexity of reconstitution is often a barrier to successful administration during a severe hypoglycemic event. Studies suggest successful administration of glucagon emergency kits range from 6%-56% of the time. Second-generation glucagon treatments and glucagon analogs do not require reconstitution and have caregiver administration success rates ranging from 94%-100%. Dasiglucagon is a glucagon analog administered via autoinjector or prefilled syringe and has been shown to result in rapid hypoglycemia recovery. Moreover, the autoinjector can be administered successfully 94% of the time by trained caregivers. Previous evaluation of costs in budget impact models (BIMs) demonstrated the potential for second-generation glucagon treatments to reduce the cost of SH events (SHEs). The current model expands on those findings with a treatment pathway and accompanying assumptions reflecting important aspects of real-world SHE treatment. OBJECTIVE: To evaluate the economic impact of dasiglucagon compared with available glucagon treatments for SHE management, considering direct cost of treatment and health care resource utilization. METHODS: A 1-year BIM with a hypothetical US commercial health plan of 1 million lives was developed with a target population of individuals with diabetes at risk of SHE. The treatment pathway model included initial and secondary treatment attempts, treatment administration success and failure, plasma glucose (PG) recovery within 15 minutes, emergency medical services, emergency department (ED) visits, and hospitalizations. A 1-way sensitivity analysis was conducted to assess the sensitivity of the model to changes in parameter values. RESULTS: In a 1 million-covered lives population, it was estimated that 12,006 SHEs would occur annually. The higher rate of initial treatment success and PG recovery within 15 minutes associated with dasiglucagon treatment resulted in lower total health care costs. Total SHE treatment costs with dasiglucagon were estimated at $13.4 million, compared with $16.7 million for injectable native glucagon, $20.7 million for nasal glucagon, $35.3 million for reconstituted glucagon, and $43.8 million for untreated individuals. Compared with untreated people, the number needed to treat (NNT) with dasiglucagon was 6 individuals to avoid 1 hospitalization. NNT for this same comparison was 59 for injectable native glucagon and 27 for nasal glucagon. CONCLUSIONS: Treatment of SH with dasiglucagon decreased total direct medical costs by reducing health care resource utilization (emergency calls, emergency transports, ED visits, and hospitalizations) and accompanying costs associated with the treatment of SH. DISCLOSURES: This research was funded by Zealand Pharma. Bromley, Hinahara, and Goss are employed by Boston Healthcare Associates, Inc., which received funding from Zealand Pharma for development of the health economic model and the manuscript. Kendall and Hammer are employed by Zealand Pharma. Weinzimer has received consulting fees from Zealand Pharma.
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Loganadan NK, Huri HZ, Vethakkan SR, Hussein Z. Pharmacogenetics of sulfonylurea-induced hypoglycemia in Type 2 diabetes patients: the SUCLINGEN study. Pharmacogenomics 2021; 22:1057-1068. [PMID: 34665019 DOI: 10.2217/pgs-2021-0059] [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: 11/21/2022] Open
Abstract
Aim: This study investigated the incidence of sulfonylurea-induced hypoglycemia and its predictors in Type 2 diabetes (T2D) patients. Patients & methods: In this prospective, observational study, T2D patients on maximal sulfonylurea-metformin therapy >1 year were enrolled. Hypoglycemia was defined as having symptoms or a blood glucose level <3.9 mmol/l. Results: Of the 401 patients, 120 (29.9%) developed sulfonylurea-induced hypoglycemia during the 12-month follow-up. The ABCC8 rs757110, KCNJ11 rs5219, CDKAL1 rs7756992 and KCNQ1 rs2237892 gene polymorphisms were not associated with sulfonylurea-induced hypoglycemia (p > 0.05). Prior history of hypoglycemia admission (odds ratio = 16.44; 95% CI: 1.74-154.33, p = 0.014) independently predicted its risk. Conclusion: Sulfonylurea-treated T2D patients who experienced severe hypoglycemia are at increased risk of future hypoglycemia episodes.
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Affiliation(s)
- Navin Kumar Loganadan
- Department of Pharmacy, Putrajaya Hospital, Precinct 7, Putrajaya, 62250, Malaysia.,Faculty of Pharmacy, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Hasniza Zaman Huri
- Faculty of Pharmacy, University of Malaya, Kuala Lumpur, 50603, Malaysia.,Clinical Investigation Centre, 5th Floor, East Tower, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Shireene Ratna Vethakkan
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Zanariah Hussein
- Department of Medicine, Putrajaya Hospital, Precinct 7, Putrajaya, 62250, Malaysia
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Yosef T. Hypoglycemia Among Type 1 Diabetes Patients After Insulin Use in Southwest Ethiopia. Front Endocrinol (Lausanne) 2021; 12:684570. [PMID: 34690922 PMCID: PMC8531583 DOI: 10.3389/fendo.2021.684570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Glycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia. MATERIALS AND METHODS A hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia. RESULTS Out of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19-0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14-0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06-4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30-0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44-10.7)] were factors associated with hypoglycemia. CONCLUSIONS The prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit.
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Affiliation(s)
- Tewodros Yosef
- *Correspondence: Tewodros Yosef, ; orcid.org/0000-0002-3173-6753
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Mönnig E, Spaepen E, Osumili B, Mitchell BD, Snoek F, Peyrot M, Kern W, Holstein A. Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers. Exp Clin Endocrinol Diabetes 2020; 130:145-155. [PMID: 33368091 DOI: 10.1055/a-1310-7963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events. METHODS Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany. RESULTS Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion. CONCLUSIONS The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.
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Affiliation(s)
| | | | | | | | - Frank Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark Peyrot
- Loyola University Maryland, Baltimore, Maryland, USA
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Fun JRS, Chia MYC. Hypoglycemic cardiac arrest and rapid return-of-spontaneous circulation (ROSC) with dextrose. Am J Emerg Med 2020; 38:1981.e1-1981.e3. [PMID: 32461056 DOI: 10.1016/j.ajem.2020.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022] Open
Abstract
Hypoglycemia was part of the "H's and T's" in the 2005 American Heart Association ACLS guidelines for reversible causes of cardiac arrest but was removed in subsequent editions. We present a case of return of spontaneous circulation in a patient with cardiac arrest after administration of dextrose for hypoglycemia. Routine administration of dextrose to patients in cardiac arrest has been shown to be associated with increased mortality and worse neurological outcomes. However, this case reminds the clinician to consider hypoglycemia in patients with cardiac arrest, and to attempt correcting a low blood glucose if noted.
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Jude EB, O'Leary C, Myland M, Nixon M, Gooch N, Shaunik A, Lew E. Evaluating glycaemic control in patients poorly controlled on oral antidiabetic drugs in real-world setting: Results from assessing the Appropriate Timing of Type 2 diAbetes INtensification (ATTAIN). Endocrinol Diabetes Metab 2020; 3:e00094. [PMID: 31922021 PMCID: PMC6947702 DOI: 10.1002/edm2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/11/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Many patients with type 2 diabetes mellitus (DM) fail to achieve glycaemic control despite recommended treatment strategies to reduce glycated haemoglobin (HbA1c). This real-world retrospective cohort study compared HbA1c change and treatment patterns between those intensifying and not intensifying therapy with oral antidiabetic drugs (OADs). MATERIALS AND METHODS Patients suboptimally controlled on OADs (>58 mmol/mol [>7.5%] or >64 mmol/mol [>8.0%] for high risk, index 1) were included from IQVIA Medical Research Data. Intensifiers within 12 months of index 1 were matched (1:1) to nonintensifiers. Primary outcomes were HbA1c change and proportion of participants achieving HbA1c targets 6 and 12 months post-index 2 (date of intensification [intensifiers] or pseudodate [nonintensifiers]). Therapy adherence was also assessed. RESULTS A total of 10 832 participants (5539 intensifiers and 5293 nonintensifiers) were included. Mean HbA1c decrease from baseline to 6 months was -1.13% (intensifiers) vs -0.75% (nonintensifiers), with no substantial further change at 12 months. Cox proportional hazards (PH) analysis suggested a nearly 20% greater chance of target achievement at 6 months for intensifiers vs nonintensifiers (hazard ratio [HR]: 0.79 [95% confidence interval [CI]: 0.73-0.86]), which was similar at 12 months (HR: 0.80 [95% CI: 0.74-0.86]). Intensifiers tended towards greater adherence to baseline therapy (90% [standard deviation (SD): 14.9] vs nonintensifiers 87% [SD: 16.0]), which decreased following intensification. CONCLUSIONS Significant reductions in HbA1c were evident at 6 months and were greater in intensifiers vs nonintensifiers. Little additional clinical benefit was seen 12 months postintensification. Despite good treatment adherence, many participants failed to achieve target HbA1c; actions beyond improved adherence are needed to improve suboptimal HbA1c.
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Affiliation(s)
- Edward B. Jude
- Diabetes CentreTameside General HospitalAshton‐under‐LyneUK
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Kahsay H, Fantahun B, Nedi T, Demoz GT. Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. J Diabetes Res 2019; 2019:9037374. [PMID: 31093506 PMCID: PMC6481033 DOI: 10.1155/2019/9037374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/09/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypoglycemia is one of the most common acute complications of type 1 diabetes mellitus (T1DM). The knowledge of the factors associated with hypoglycemia will help in the prevention and management of the problem. Therefore, this study was conducted to assess hypoglycemia and its associated factors among T1DM patients who attended the diabetes outpatient clinic of St. Paul's Hospital Millennium Medical College (SPHMMC). METHODS A cross-sectional study was conducted at the diabetes clinic of SPHMMC. Data on sociodemographic and clinical characteristics including duration of diabetes, type of insulin they have been taking, the factors associated with hypoglycemia, and the severity stage of hypoglycemia was obtained. Data was collected using a structured questionnaire and chart review. Multivariate logistic regression model was used to identify factors associated with hypoglycemia. RESULT Out of the 247 participants who were recruited into the study, 233 (94.3%) of them experienced hypoglycemia. A total of 6.9 events of hypoglycemia per patient per year happened. Particularly, the events were categorized as 3.1 mild events, 2.3 moderate events, and 0.93 severe events of hypoglycemia. Shorter duration of diabetes history (<1 year) was significantly associated with less experience of hypoglycemia (AOR = 0.09, 95% CI: 0.01-0.90). However, blood glucose monitoring at home was found to be significantly associated with more report of hypoglycemia (AOR = 5.77, 95% CI: 1.16-28.66). CONCLUSION The prevalence of hypoglycemia among T1DM patients was found as substantially high. Self/family blood glucose monitoring at home could not guarantee to minimize the occurrence of hypoglycemia events. Finger stick home blood glucose monitoring should be given a special attention. Therefore, the involvement of health care providers in diabetes care should be encouraged to address the occurrence of hypoglycemia in T1DM patients.
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Affiliation(s)
- Halefom Kahsay
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Bereket Fantahun
- Department of Pediatrics, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teshome Nedi
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gebre Teklemariam Demoz
- School of Pharmacy, College of Health Sciences, Aksum University, P.O. Box: 298, Aksum, Ethiopia
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Saikawa R, Yamada H, Suzuki D, Amamoto M, Matsumoto Y, Funazaki S, Yoshida M, Toyoshima H, Hara K. Risk Factors of Hypoglycemic Encephalopathy and Prolonged Hypoglycemia in Patients With Severe Hypoglycemia. J Clin Med Res 2019; 11:213-218. [PMID: 30834045 PMCID: PMC6396785 DOI: 10.14740/jocmr3728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the study was to investigate risk factors of hypoglycemic encephalopathy (HE) in patients with severe hypoglycemia. Methods We retrospectively enrolled patients with severe hypoglycemia who were transported to the emergency department in an ambulance. We defined severe hypoglycemia as plasma glucose level < 60 mg/dL (or capillary levels < 50 mg/dL). HE was defined as severe hypoglycemia with altered level of consciousness (Glasgow coma scale < 12) and prolonged HE as coma or stupor lasting > 24 h after glucose administration. We compared several parameters between patients with and without HE and between prolonged and recovered patients. Results Included were 173 patients with severe hypoglycemia; of them, 94 were diagnosed with HE, with 12 of them prolonged HE. Glucose level in HE patients was lower than that in those without HE (P < 0.001). Moreover, we noted a significant difference in glucose levels between the prolonged and recovered groups. Furthermore, body temperature was higher in prolonged versus recovered patients (P = 0.0017). Conclusion Blood glucose level may be correlated with severity of altered level of consciousness. In addition, body temperature may be related to coma or prolonged stupor.
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Affiliation(s)
- Rika Saikawa
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Hodaka Yamada
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Daisuke Suzuki
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Misato Amamoto
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Yuko Matsumoto
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Shunsuke Funazaki
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Masashi Yoshida
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Hideo Toyoshima
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
| | - Kazuo Hara
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Japan
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Pan QX, Li XJ, Liu YY, Wang FF, Hou YJ, Bian QL, Qiu WQ, Yan ZY, Jiang YM, Chen JX. Relationship between Insulin Levels and Nonpsychotic Dementia: A Systematic Review and Meta-Analysis. Neural Plast 2017; 2017:1230713. [PMID: 29445549 PMCID: PMC5763205 DOI: 10.1155/2017/1230713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To explore the relationship between insulin levels and nonpsychotic dementia. Methods Six electronic databases (PubMed, Cochrane, SCI, CNKI, VIP, and Wanfang) were searched from January 1, 2007, to March 1, 2017. Experimental or observational studies that enrolled people with nonpsychotic dementia or abnormal insulin levels in which insulin levels or MMSE scores (events in nonpsychotic dementia) were the outcome measures. Random-effects models were chosen for this meta-analysis. Sample size, mean, s.d., and events were primarily used to generate effect sizes (with the PRIMA registration number CRD42017069860). Results 50 articles met the final inclusion criteria. Insulin levels in cerebrospinal fluid were lower (Hedges' g = 1.196, 95% CI = 0.238 to 2.514, and P = 0.014), while the levels in peripheral blood were higher in nonpsychotic dementia patients (Hedges' g = 0.853 and 95% CI = 0.579 to 1.127), and MMSE scores were significantly lower in the high insulin group than in the healthy control group (Hedges' g = 0.334, 95% CI = 0.249 to 0.419, and P = 0.000). Conclusions Our comprehensive results indicate that blood insulin levels may increase in patients with nonpsychotic dementia.
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Affiliation(s)
- Qiu-xia Pan
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Xiao-juan Li
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Yue-yun Liu
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Fang-fang Wang
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Ya-jing Hou
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Qing-lai Bian
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Wen-qi Qiu
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Zhi-yi Yan
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - You-ming Jiang
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
| | - Jia-xu Chen
- School of Basic Medical Science, Beijing University of Chinese Medicine, No. 11 North Third Ring Road, Chaoyang, Beijing 100029, China
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