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Troncone A, Piscopo A, Zanfardino A, Chianese A, Cascella C, Affuso G, Borriello A, Curto S, Rollato AS, Testa V, Del Giudice EM, Magliano L, Iafusco D. Fear of hypoglycemia in parents of children with type 1 diabetes trained for intranasal glucagon use. J Psychosom Res 2024; 184:111856. [PMID: 38972099 DOI: 10.1016/j.jpsychores.2024.111856] [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: 12/06/2023] [Revised: 03/25/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To investigate fear of hypoglycemia (FoH) in parents of children with type 1 diabetes (T1D) before and after undergoing training to learn intranasal (IN) glucagon administration. METHOD In this pre-test/post-test uncontrolled study 364 caregivers of patients with T1D (6-18 years) completed questionnaires measuring sociodemographic characteristics, diabetes-related factors (e.g., type of insulin therapy, glycemic control), and parents' trait anxiety. Parents' FoH was assessed at baseline (T0, training) and after nine months (T1). Two repeated-measure mixed analyses of covariance (ANCOVA) compared the FoH at T0 and at T1 and analyzed the moderating roles of anxiety proneness and type of insulin therapy, as well as of anxiety proneness and use of sensor. Age, T1D duration, HbA1c values, and SES were included as covariates. RESULTS Parental FoH at T1 (M = 1.72; SE = 0.06/M = 1.57; SE = 0.09) was significantly lower than parental FoH at T0 (M = 1.89; SE = 0.06/M = 1.77; SE = 0.09). The group with high trait-anxiety had a higher level of FoH (M = 2.05; SE = 0.08/M = 1.89; SE = 0.12) than the group with low trait-anxiety (M = 1.57; SE = 0.08/M = 1.46; SE = 0.09) at both time points. SES was negatively associated with FoH at T0 (t = -2.87; p = .004/t = -2.87; p = .005). No other significant effects were found. CONCLUSIONS Training and educating parents on IN glucagon use can help them effectively manage hypoglycemic episodes and alleviate the fear that generally accompany such events.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Alessia Piscopo
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gaetana Affuso
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Anna Borriello
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Stefano Curto
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Assunta Serena Rollato
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Veronica Testa
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lorenza Magliano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Giménez M, Khunti K, Matsuhisa M, Chenji S, Syring K, Yan Y. Systematic Literature Review and Indirect Treatment Comparison of Three Ready-to-Use Glucagon Treatments for Severe Hypoglycemia. Diabetes Ther 2023; 14:1757-1769. [PMID: 37707700 PMCID: PMC10570215 DOI: 10.1007/s13300-023-01466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Ready-to-use glucagon represents a significant advancement in the management of severe hypoglycemia for people with diabetes and their caregivers. This indirect treatment comparison (ITC) evaluated the efficacy and safety differences among the three ready-to-use glucagon treatments, Baqsimi® (nasal glucagon), Gvoke® (glucagon injection) and Zegalogue® (dasiglucagon injection), in adults and children with type 1 diabetes (T1D) or type 2 diabetes (T2D). METHODS A systematic literature review was conducted to identify randomized clinical trials assessing the efficacy and safety of Baqsimi, Gvoke or Zegalogue versus reconstituted, injectable glucagon (IG) in reversing insulin-induced hypoglycemia. Bayesian fixed-effect network meta-analysis was used to perform the ITC. Study endpoints included proportion of participants achieving treatment success, maximum blood glucose achieved, time to achieve treatment success and maximum blood glucose and treatment-emergent adverse events (TEAE). RESULTS Ten clinical trials were included in the ITC (four for Baqsimi, three for Gvoke, and three for Zegalogue). All three treatments achieved high proportions of treatment success (> 98%). In adults, the efficacy results from combined T1D and T2D analysis were consistent with the T1D analysis, except statistically significantly faster in achieving treatment success for Baqsimi vs Gvoke in the combined analysis (13.96 vs 14.66 min). The mean maximum blood glucose values were also statistically significantly lower for Baqsimi (168 mg/dl) vs Gvoke (220 mg/dl) and Zegalogue (190 mg/dl). There was a trend towards a lower number of adults experiencing ≥ 1 TEAE with Baqsimi compared to Gvoke or Zegalogue, but no statistical significance was reached. CONCLUSION Baqsimi, Gvoke and Zegalogue had comparable high proportions of treatment success in reversing insulin-induced hypoglycemia. Baqsimi achieved a lower mean maximum blood glucose value, which may have implications for the re-establishment of euglycemia. These findings may help support patients, caregivers and health care providers in their decision-making process when discussing various ready-to-use glucagon treatment options.
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Affiliation(s)
| | | | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Suresh Chenji
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Kristen Syring
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Yu Yan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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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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Shi YF, Jiang YP, Wang XZ, Sun PP, Zhu NJ, Wang K, Zhang ZQ, Liu YY, Huo J, Wang XR, Ding B. Chiral Luminescent Sensor Eu-BTB@d-Carnitine Applied in the Highly Effective Ratiometric Sensing of Curing Drugs and Biomarkers for Diabetes and Hypertension. Inorg Chem 2022; 61:15921-15935. [PMID: 36170648 DOI: 10.1021/acs.inorgchem.2c02126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chiral drugs are of great significance in drug development and life science because one pair of enantiomers has a different combination mode with target biological active sites, leading to a vast difference in physical activity. Metal-organic framework (MOF)-based chiral hybrid materials with specific chiral sites have excellent applications in the highly effective sensing of drug enantiomers. Sitagliptin and clonidine are effective curing drugs for controlling diabetes and hypertension, while insulin and norepinephrine are the biomarkers of these two diseases. Excessive use of sitagliptin and clonidine can cause side effects such as stomach pain, nausea, and headaches. Herein, through post-synthetic strategy, MOF-based chiral hybrid material Eu-BTB@d-carnitine (H3BTB = 1,3,5-benzenetrisbenzoic acid) was synthesized. Eu-BTB@d-carnitine has dual emission peaks at 417 and 616 nm when excited at 330 nm. Eu-BTB@d-carnitine can be applied in luminescent recognition toward sitagliptin and clonidine with high sensitivity and low detection limit (for sitagliptin detection, Ksv is 7.43 × 106 [M-1]; for clonidine detection, Ksv is 9.09 × 106 [M-1]; limit of detection (LOD) for sitagliptin is 10.21 nM, and LOD of clonidine is 8.34 nM). In addition, Eu-BTB@d-carnitine can further realize highly sensitive detection of insulin in human fluids with a high Ksv (2.08 × 106 [M-1]) and a low LOD (15.48 nM). On the other hand, norepinephrine also can be successfully discriminated by the hybrid luminescent platform of Eu-BTB@d-carnitine and clonidine with a high Ksv value of 4.79 × 106 [M-1] and a low LOD of 8.37 nM. As a result, the chiral hybrid material Eu-BTB@d-carnitine can be successfully applied in the highly effective ratiometric sensing of curing drugs and biomarkers for diabetes and hypertension.
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Affiliation(s)
- Yang Fan Shi
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Yu Peng Jiang
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Xing Ze Wang
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Ping Ping Sun
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Na Jia Zhu
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Kuo Wang
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Zi Qing Zhang
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Yuan Yuan Liu
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - JianZhong Huo
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Xin Rui Wang
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
| | - Bin Ding
- Tianjin Key Laboratory of Structure and Performance for Functional Molecule, College of Chemistry, Tianjin Normal University, 393 Binshui West Road, Tianjin 300387, PR China
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Zhang L, Xu H, Liu L, Bi Y, Li X, Kan Y, Liu H, Li S, Zou Y, Yuan Y, Gong W, Zhang Y. Related factors associated with fear of hypoglycemia in parents of children and adolescents with type 1 diabetes - A systematic review. J Pediatr Nurs 2022; 66:125-135. [PMID: 35716460 DOI: 10.1016/j.pedn.2022.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022]
Abstract
PROBLEM Fear of hypoglycemia is a significant concern for parents of children/ adolescents with type 1 diabetes. Although some studies have explained the parental fear of hypoglycemia, the related factors were yet to be determined. This systematic review aims to identify the related factors of fear of hypoglycemia in the parents of children and adolescents with type 1 diabetes and provide a theoretical basis for further intervention. ELIGIBILITY CRITERIA PubMed, MEDLINE, EMBASE, Scopus, CINAHL, EBSCO, Web of Science, and Cochrane Library were systematically searched from 2010 to 2021. Studies evaluating the fear of hypoglycemia of parents and its associated factors were included. SAMPLE Twenty-three observational articles met the criteria. RESULTS Significant associations were found between fear of hypoglycemia and specific factors, including motherhood, nocturnal hypoglycemia, and the number of blood glucose monitoring. Psychological factors, including anxiety, depression, pediatric parenting stress, mindfulness, self-efficacy, quality of life, and sleep disorders, were conclusive and associations with parental fear of hypoglycemia. CONCLUSIONS Understanding parental fear of hypoglycemia can help parents prevent potential problems in diabetes management, thus promoting children's growth. According to current evidence, effective targeted interventions based on modifiable relevant factors can be developed to reduce the fear of hypoglycemia in parents while maintaining optimal blood glucose control in children/ adolescents. IMPLICATIONS Health professionals should pay more attention to the mental health of parents, and parents should be involved in the care plan and have the opportunity to discuss their fear of hypoglycemia in the most appropriate way to manage type 1 diabetes.
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Affiliation(s)
- Lu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Huiwen Xu
- School of Nursing, Yangzhou University, Yangzhou, China; Nagano College of Nursing, Komagane, Nagano 399-4117, Japan
| | - Lin Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yaxin Bi
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Xiangning Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yinshi Kan
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Hongyuan Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Shuang Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yan Zou
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weijuan Gong
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China; Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China.
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Chapman K, Hughes AS, Bispham J, Leon C, Nguyen H, Wolf WA. Emergency Glucagon: a Focused Review of Psychosocial Experiences of Rescue Drugs for Type 1 Diabetes. Curr Diab Rep 2022; 22:189-197. [PMID: 35171447 DOI: 10.1007/s11892-021-01443-y] [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] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to describe rescue glucagon types, safety, efficacy, and preferences, as well as to review articles regarding emergency glucagon usage, severe hypoglycemia, and the emotions of both phenomena. We conducted a review of current literature on glucagon usage and the emotional impact of severe hypoglycemia on people with diabetes (PwD) and the caregivers of people with type 1 diabetes (T1D). RECENT FINDINGS Minimal research exists pertaining to glucagon and severe hypoglycemic experiences in PwD, which is troubling considering the severity of risks and possible side effects. Recent articles described negative emotions such as fear, anxiety, stress, helplessness, shame, embarrassment, loneliness, frustration, hopefulness, and uncertainty surrounding glucagon usage. There is scarce research regarding PwD's emotions surrounding severe hypoglycemia and rescue glucagon use. Additional research is needed to investigate the emotions and feelings people with T1D and their caregivers' experience pertaining to severe hypoglycemia and emergency glucagon use.
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Affiliation(s)
- Katherine Chapman
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA.
| | - Allyson S Hughes
- Department of Primary Care, Ohio University, Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | - Carolina Leon
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
| | - Huyen Nguyen
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
| | - Wendy A Wolf
- T1D Exchange, 11 Ave de Lafayette, 5th Floor, Boston, MA, 02111, USA
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