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Gandasi NR, Rorsman P. An unclear role for the GLP-1 metabolite GLP-1(9-36) in human islet physiology. Reply to Matveyenko A, Vella A [letter]. Diabetologia 2024:10.1007/s00125-024-06140-5. [PMID: 38578450 DOI: 10.1007/s00125-024-06140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Nikhil R Gandasi
- Metabolic Physiology Unit, Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Cell Metabolism Lab (GA-08), Department of Developmental Biology and Genetics (DBG), Indian Institute of Science (IISc), Bangalore, India
| | - Patrik Rorsman
- Metabolic Physiology Unit, Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK.
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Berthon W, McGurnaghan SJ, Blackbourn LAK, Mellor J, Gibb FW, Heller S, Kennon B, McCrimmon RJ, Philip S, Sattar N, McKeigue PM, Colhoun HM. Ongoing burden and recent trends in severe hospitalised hypoglycaemia events in people with type 1 and type 2 diabetes in Scotland: A nationwide cohort study 2016-2022. Diabetes Res Clin Pract 2024; 210:111642. [PMID: 38548109 DOI: 10.1016/j.diabres.2024.111642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
AIMS We examined severe hospitalised hypoglycaemia (SHH) rates in people with type 1 and type 2 diabetes in Scotland during 2016-2022, stratifying by sociodemographics. METHODS Using the Scottish National diabetes register (SCI-Diabetes), we identified people with type 1 and type 2 diabetes alive anytime during 2016-2022. SHH events were determined through linkage to hospital admission and death registry data. We calculated annual SHH rates overall and by age, sex, and socioeconomic status. Summary estimates of time and stratum effects were obtained by fitting adjusted generalised additive models using R package mgcv. RESULTS Rates for those under 20 with type 1 diabetes reached their minimum at the 2020-2021 transition, 30% below the study period average. A gradual decline over time also occurred among 20-49-year-olds with type 1 diabetes. Overall, females had 15% higher rates than males with type 2 diabetes (rate ratio 1.15, 95% CI 1.08-1.22). People in the most versus least deprived quintile experienced 2.58 times higher rates (95% CI 2.27-2.93) in type 1 diabetes and 2.33 times higher (95% CI 2.08-2.62) in type 2 diabetes. CONCLUSIONS Despite advances in care, SHH remains a significant problem in diabetes. Future efforts must address the large socioeconomic disparities in SHH risks.
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Affiliation(s)
- William Berthon
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
| | - Stuart J McGurnaghan
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Luke A K Blackbourn
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Joseph Mellor
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Brian Kennon
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Sam Philip
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul M McKeigue
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK; Public Health Scotland, Glasgow, UK
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Blunt C, Mathew S, Mung SM, Krishnamurthy R, Jude EB. Hypoglycaemia following the 2-hour 75g OGTT in pregnancy - Investigating maternal and foetal outcomes. Diabetes Metab Syndr 2024; 18:102977. [PMID: 38503114 DOI: 10.1016/j.dsx.2024.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
AIMS To investigate differences in maternal and foetal outcomes in pregnancy, where patients developed hypoglycaemia following the 2-hour 75g oral glucose tolerance test (OGTT). METHOD A retrospective cohort study of 200 pregnancies attending the Antenatal Clinic at Tameside General Hospital between 2018 and 2022. Outcomes were compared between 4 groups: normal OGTT [G1; (n = 39, 20%), diagnosis of gestational diabetes mellitus (GDM) based on OGTT [G2; BG ≥ 5.6 mmol/L or 2-h OGTT ≥7.8 (n = 41, 21%)], hypoglycaemia [G3; 2 h OGTT 3.0-3.9 mmol/L (n = 93, 47%)], or clinically significant hypoglycaemia [G4; 2 h OGTT <3.0 mmol/L (n = 27, 14%)]. Maternal BMI, foetal birth weight (FBW), neonatal complications, neo-natal intensive care unit (NICU) stay and conversion to GDM were assessed. RESULTS Maternal BMI was lower in G3 and G4 (27.3 kg/m2 and 28.1 kg/m2 respectively) compared to G1 (30.4 kg/m2) (p = 0.02). NICU stay was more frequent in G3 (12%, n = 11) and G4 (8%, n = 2) compared to G1 (5%, n = 2). Foetal complications occurred in 27% of G3 (n = 25) and 33% of G4 (n = 9) compared to 23% in G1 (n = 9) and 17% in G2 (n = 7). FBW was similar in G1 when compared to G3 and G4 (p = 0.34). Of the 120 patients in G3 and G4, 25 patients self-monitored blood glucose for two weeks; 28% (n = 7) subsequently developed GDM. CONCLUSION Higher rates of NICU stay and foetal complications were seen in both hypoglycaemic groups. In patients with hypoglycaemia following OGTT there is evidence to support self-monitoring blood glucose as 28% were later diagnosed with GDM.
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Affiliation(s)
- Callum Blunt
- Department of Diabetes and Endocrinology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, OL6 9RW, United Kingdom
| | - Susan Mathew
- Department of Diabetes and Endocrinology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, OL6 9RW, United Kingdom
| | - Sai Man Mung
- Department of Diabetes and Endocrinology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, OL6 9RW, United Kingdom
| | - Roopa Krishnamurthy
- Department of Obstetrics and Gynaecology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, OL6 9RW, United Kingdom
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, OL6 9RW, United Kingdom; The University of Manchester, Manchester, M13 9PL, United Kingdom.
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Mikovic N, Mazzilli R, Zamponi V, Russo F, Mancini C, Mori F, Bollanti L, Conti F, Motta C, Monti S, Pugliese G, Faggiano A. Short fasting test as a reliable and effective tool to diagnose insulinoma. Endocrine 2024:10.1007/s12020-024-03759-7. [PMID: 38451386 DOI: 10.1007/s12020-024-03759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The diagnosis of insulinoma can be challenging, requiring documentation of hypoglycaemia associated with non-suppressed insulin and C-peptide, often achieved during a prolonged 72 h fast performed in inpatient setting. Our goal is to predict weather a shorter outpatient fasting test initiated overnight and prolonged up until 24 h could be a sensitive method for diagnosing insulinoma. METHODS We conducted a retrospective monocentric study on subjects admitted to our Unit of Endocrinology from 2019 to 2022 for clinical suspicion of insulinoma and underwent the short fasting test. A comparison between the short test group and the group of subjects who underwent the standard prolonged fasting test (from 2003 to 2018) has also been performed. The short fasting test was initiated by the patient overnight at home and proceeded the following day in outpatient setting (Day Hospital). As in the standard protocol, symptoms and capillary blood glucose (CBG) were strictly monitored. Venous blood was drawn for glycaemia, insulin and C-peptide at admission and at established intervals, in case of symptoms of hypoglycaemia or if CBG ≤ 45 mg/dl, when the fast would be suspended. RESULTS The final sample consisted of 37 patients, with mean age of 44.5 ± 12.6 years (17-74). Short and standard tests were performed in 15 and 22 subjects, respectively. Diagnostic values for insulinoma were observed in 12 patients: in 5/15 who underwent the short fasting test, in 6/22 who underwent the prolonged test and in 1 patient who was initially negative on the short test and subsequently showed diagnostic values during the prolonged test. The diagnosis of insulinoma was achieved in 11/12 cases within 24 h of the beginning of the fast (91.7%). CONCLUSIONS A short fasting test could be a valid, sensitive and reliable first-line workup in diagnosing insulinoma.
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Affiliation(s)
- Nevena Mikovic
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy.
| | - Rossella Mazzilli
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Virginia Zamponi
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Flaminia Russo
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Camilla Mancini
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Fedra Mori
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Lucilla Bollanti
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Francesco Conti
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Cecilia Motta
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Salvatore Monti
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Giuseppe Pugliese
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Antongiulio Faggiano
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, ENETS Excellence Center, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
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She R, Suvitaival T, Andersen HU, Hommel E, Nørgaard K, Wojtaszewski JFP, Legido-Quigley C, Pedersen-Bjergaard U. Metabolic effect of adrenaline infusion in people with type 1 diabetes and healthy individuals. Diabetologia 2024:10.1007/s00125-024-06116-5. [PMID: 38427076 DOI: 10.1007/s00125-024-06116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/03/2024] [Indexed: 03/02/2024]
Abstract
AIMS/HYPOTHESIS As a result of early loss of the glucagon response, adrenaline is the primary counter-regulatory hormone in type 1 diabetes. Diminished adrenaline responses to hypoglycaemia due to counter-regulatory failure are common in type 1 diabetes, and are probably induced by exposure to recurrent hypoglycaemia, however, the metabolic effects of adrenaline have received less research attention, and also there is conflicting evidence regarding adrenaline sensitivity in type 1 diabetes. Thus, we aimed to investigate the metabolic response to adrenaline and explore whether it is modified by prior exposure to hypoglycaemia. METHODS Eighteen participants with type 1 diabetes and nine healthy participants underwent a three-step ascending adrenaline infusion during a hyperinsulinaemic-euglycaemic clamp. Continuous glucose monitoring data obtained during the week before the study day were used to assess the extent of hypoglycaemia exposure. RESULTS While glucose responses during the clamp were similar between people with type 1 diabetes and healthy participants, plasma concentrations of NEFAs and glycerol only increased in the group with type 1 diabetes (p<0.001). Metabolomics revealed an increase in the most common NEFAs (p<0.01). Other metabolic responses were generally similar between participants with type 1 diabetes and healthy participants. Exposure to hypoglycaemia was negatively associated with the NEFA response; however, this was not statistically significant. CONCLUSIONS/INTERPRETATION In conclusion, individuals with type 1 diabetes respond with increased lipolysis to adrenaline compared with healthy participants by mobilising the abundant NEFAs in plasma, whereas other metabolic responses were similar. This may suggest that the metabolic sensitivity to adrenaline is altered in a pathway-specific manner in type 1 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT05095259.
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Affiliation(s)
- Rui She
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Eva Hommel
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kirsten Nørgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Cristina Legido-Quigley
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Giorgino F, Guja C, Aydın H, Lauand F, Melas-Melt L, Rosenstock J. Consistent glycaemic efficacy and safety of concomitant use of iGlarLixi and sodium-glucose co-transporter-2 inhibitor therapy for type 2 diabetes: A patient-level pooled analysis of three randomised clinical trials. Diabetes Res Clin Pract 2024; 209:111604. [PMID: 38447911 DOI: 10.1016/j.diabres.2024.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
AIMS Sodium glucose co-transporter 2 inhibitors (SGLT2is) and/or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with proven cardio- and reno-protective benefits are recommended in people with type 2 diabetes (T2D) at high risk of cardiovascular disease, chronic kidney disease, and/or heart failure. This pooled analysis compared efficacy and safety outcomes of iGlarLixi with or without SGLT2is in people with T2D. METHODS This post hoc analysis evaluated outcomes in participants who were receiving an SGLT2i when initiating iGlarLixi (SGLT2i users) and those who were not (SGLT2i non-users) in a pooled dataset from three trials: LixiLan-G (advancing from a GLP-1 RA), SoliMix and LixiLan ONE CAN (advancing from basal insulin). RESULTS Baseline characteristics were generally similar between 219 users and 746 non-users. Least squares mean changes in HbA1c from baseline to Week 26 were similar for users (-1.2 % [95 % confidence intervals: -1.4 %, -1.1 %]) and non-users (-1.2 % [-1.2 %, -1.1 %]). Changes in body weight, fasting glucose and post-prandial glucose were similar between groups, as were hypoglycaemic events. CONCLUSIONS Pooled results from three studies of adults with T2D demonstrated that iGlarLixi provided similar clinically meaningful improvements in glycaemic control without increased hypoglycaemia risk, regardless of concomitant use of SGLT2is.
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Affiliation(s)
- Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari 70124, Italy.
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest 030167, Romania.
| | - Hasan Aydın
- Department of Endocrinology, Yeditepe University School of Medicine, Istanbul 34724, Turkey.
| | | | | | - Julio Rosenstock
- Velocity Clinical Research at Medical City, 75230 Dallas, TX, USA.
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Fabricius TW, Verhulst CEM, Kristensen PL, Holst JJ, Tack CJ, McCrimmon RJ, Heller SR, Evans ML, de Galan BE, Pedersen-Bjergaard U. Counterregulatory hormone and symptom responses to hypoglycaemia in people with type 1 diabetes, insulin-treated type 2 diabetes or without diabetes: the Hypo-RESOLVE hypoglycaemic clamp study. Acta Diabetol 2024:10.1007/s00592-024-02239-8. [PMID: 38376580 DOI: 10.1007/s00592-024-02239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
AIM The sympathetic nervous and hormonal counterregulatory responses to hypoglycaemia differ between people with type 1 and type 2 diabetes and may change along the course of diabetes, but have not been directly compared. We aimed to compare counterregulatory hormone and symptom responses to hypoglycaemia between people with type 1 diabetes, insulin-treated type 2 diabetes and controls without diabetes, using a standardised hyperinsulinaemic-hypoglycaemic clamp. MATERIALS We included 47 people with type 1 diabetes, 15 with insulin-treated type 2 diabetes, and 32 controls without diabetes. Controls were matched according to age and sex to the people with type 1 diabetes or with type 2 diabetes. All participants underwent a hyperinsulinaemic-euglycaemic-(5.2 ± 0.4 mmol/L)-hypoglycaemic-(2.8 ± 0.13 mmol/L)-clamp. RESULTS The glucagon response was lower in people with type 1 diabetes (9.4 ± 0.8 pmol/L, 8.0 [7.0-10.0]) compared to type 2 diabetes (23.7 ± 3.7 pmol/L, 18.0 [12.0-28.0], p < 0.001) and controls (30.6 ± 4.7, 25.5 [17.8-35.8] pmol/L, p < 0.001). The adrenaline response was lower in type 1 diabetes (1.7 ± 0.2, 1.6 [1.3-5.2] nmol/L) compared to type 2 diabetes (3.4 ± 0.7, 2.6 [1.3-5.2] nmol/L, p = 0.001) and controls (2.7 ± 0.4, 2.8 [1.4-3.9] nmol/L, p = 0.012). Growth hormone was lower in people with type 2 diabetes than in type 1 diabetes, at baseline (3.4 ± 1.6 vs 7.7 ± 1.3 mU/L, p = 0.042) and during hypoglycaemia (24.7 ± 7.1 vs 62.4 ± 5.8 mU/L, p = 0.001). People with 1 diabetes had lower overall symptom responses than people with type 2 diabetes (45.3 ± 2.7 vs 58.7 ± 6.4, p = 0.018), driven by a lower neuroglycopenic score (27.4 ± 1.8 vs 36.7 ± 4.2, p = 0.012). CONCLUSION Acute counterregulatory hormone and symptom responses to experimental hypoglycaemia are lower in people with type 1 diabetes than in those with long-standing insulin-treated type 2 diabetes and controls.
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Affiliation(s)
- Therese W Fabricius
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.
| | - Clementine E M Verhulst
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - 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
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Mark L Evans
- Welcome MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht UMC+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ulrik Pedersen-Bjergaard
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Farrell CM, McNeilly AD, Hapca S, Fournier PA, Jones TW, Facchinetti A, Cappon G, West DJ, McCrimmon RJ. High intensity interval training as a novel treatment for impaired awareness of hypoglycaemia in people with type 1 diabetes (HIT4HYPOS): a randomised parallel-group study. Diabetologia 2024; 67:392-402. [PMID: 38010533 PMCID: PMC10789679 DOI: 10.1007/s00125-023-06051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
AIMS/HYPOTHESIS Impaired awareness of hypoglycaemia (IAH) in type 1 diabetes may develop through a process referred to as habituation. Consistent with this, a single bout of high intensity interval exercise as a novel stress stimulus improves counterregulatory responses (CRR) to next-day hypoglycaemia, referred to as dishabituation. This longitudinal pilot study investigated whether 4 weeks of high intensity interval training (HIIT) has sustained effects on counterregulatory and symptom responses to hypoglycaemia in adults with type 1 diabetes and IAH. METHODS HIT4HYPOS was a single-centre, randomised, parallel-group study. Participants were identified using the Scottish Diabetes Research Network (SDRN) and from diabetes outpatient clinics in NHS Tayside, UK. The study took place at the Clinical Research Centre, Ninewells Hospital and Medical School, Dundee, UK. Participants were aged 18-55 years with type 1 diabetes of at least 5 years' duration and HbA1c levels <75 mmol/mol (<9%). They had IAH confirmed by a Gold score ≥4, modified Clarke score ≥4 or Dose Adjustment For Normal Eating [DAFNE] hypoglycaemia awareness rating of 2 or 3, and/or evidence of recurrent hypoglycaemia on flash glucose monitoring. Participants were randomly allocated using a web-based system to either 4 weeks of real-time continuous glucose monitoring (RT-CGM) or RT-CGM+HIIT. Participants and investigators were not masked to group assignment. The HIIT programme was performed for 20 min on a stationary exercise bike three times a week. Hyperinsulinaemic-hypoglycaemic (2.5 mmol/l) clamp studies with assessment of symptoms, hormones and cognitive function were performed at baseline and after 4 weeks of the study intervention. The predefined primary outcome was the difference in hypoglycaemia-induced adrenaline (epinephrine) responses from baseline following RT-CGM or RT-CGM+HIIT. RESULTS Eighteen participants (nine men and nine women) with type 1 diabetes (median [IQR] duration 27 [18.75-32] years) and IAH were included, with nine participants randomised to each group. Data from all study participants were included in the analysis. During the 4 week intervention there were no significant mean (SEM) differences between RT-CGM and RT-CGM+HIIT in exposure to level 1 (28 [7] vs 22 [4] episodes, p=0.45) or level 2 (9 [3] vs 4 [1] episodes, p=0.29) hypoglycaemia. The CGM-derived mean glucose level, SD of glucose and glucose management indicator (GMI) did not differ between groups. During the hyperinsulinaemic-hypoglycaemic clamp studies, mean (SEM) change from baseline was greater for the noradrenergic responses (RT-CGM vs RT-CGM+HIIT: -988 [447] vs 514 [732] pmol/l, p=0.02) but not the adrenergic responses (-298 [687] vs 1130 [747] pmol/l, p=0.11) in those participants who had undergone RT-CGM+HIIT. There was a benefit of RT-CGM+HIIT for mean (SEM) change from baseline in the glucagon CRR to hypoglycaemia (RT-CGM vs RT-CGM+HIIT: 1 [4] vs 16 [6] ng/l, p=0.01). Consistent with the hormone response, the mean (SEM) symptomatic response to hypoglycaemia (adjusted for baseline) was greater following RT-CGM+HIIT (RT-CGM vs RT-CGM+HIIT: -4 [2] vs 0 [2], p<0.05). CONCLUSIONS/INTERPRETATION In this pilot clinical trial in people with type 1 diabetes and IAH, we found continuing benefits of HIIT for overall hormonal and symptomatic CRR to subsequent hypoglycaemia. Our findings also suggest that HIIT may improve the glucagon response to insulin-induced hypoglycaemia. TRIAL REGISTRATION ISRCTN15373978. FUNDING Sir George Alberti Fellowship from Diabetes UK (CMF) and the Juvenile Diabetes Research Foundation.
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Affiliation(s)
- Catriona M Farrell
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Alison D McNeilly
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Simona Hapca
- Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | | | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Daniel J West
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK.
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Castillo-Armengol J, Marzetta F, Rodriguez Sanchez-Archidona A, Fledelius C, Evans M, McNeilly A, McCrimmon RJ, Ibberson M, Thorens B. Disrupted hypothalamic transcriptomics and proteomics in a mouse model of type 2 diabetes exposed to recurrent hypoglycaemia. Diabetologia 2024; 67:371-391. [PMID: 38017352 PMCID: PMC10789691 DOI: 10.1007/s00125-023-06043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/07/2023] [Indexed: 11/30/2023]
Abstract
AIMS/HYPOTHESIS Repeated exposures to insulin-induced hypoglycaemia in people with diabetes progressively impairs the counterregulatory response (CRR) that restores normoglycaemia. This defect is characterised by reduced secretion of glucagon and other counterregulatory hormones. Evidence indicates that glucose-responsive neurons located in the hypothalamus orchestrate the CRR. Here, we aimed to identify the changes in hypothalamic gene and protein expression that underlie impaired CRR in a mouse model of defective CRR. METHODS High-fat-diet fed and low-dose streptozocin-treated C57BL/6N mice were exposed to one (acute hypoglycaemia [AH]) or multiple (recurrent hypoglycaemia [RH]) insulin-induced hypoglycaemic episodes and plasma glucagon levels were measured. Single-nuclei RNA-seq (snRNA-seq) data were obtained from the hypothalamus and cortex of mice exposed to AH and RH. Proteomic data were obtained from hypothalamic synaptosomal fractions. RESULTS The final insulin injection resulted in similar plasma glucose levels in the RH group and AH groups, but glucagon secretion was significantly lower in the RH group (AH: 94.5±9.2 ng/l [n=33]; RH: 59.0±4.8 ng/l [n=37]; p<0.001). Analysis of snRNA-seq data revealed similar proportions of hypothalamic cell subpopulations in the AH- and RH-exposed mice. Changes in transcriptional profiles were found in all cell types analysed. In neurons from RH-exposed mice, we observed a significant decrease in expression of Avp, Pmch and Pcsk1n, and the most overexpressed gene was Kcnq1ot1, as compared with AH-exposed mice. Gene ontology analysis of differentially expressed genes (DEGs) indicated a coordinated decrease in many oxidative phosphorylation genes and reduced expression of vacuolar H+- and Na+/K+-ATPases; these observations were in large part confirmed in the proteomic analysis of synaptosomal fractions. Compared with AH-exposed mice, oligodendrocytes from RH-exposed mice had major changes in gene expression that suggested reduced myelin formation. In astrocytes from RH-exposed mice, DEGs indicated reduced capacity for neurotransmitters scavenging in tripartite synapses as compared with astrocytes from AH-exposed mice. In addition, in neurons and astrocytes, multiple changes in gene expression suggested increased amyloid beta (Aβ) production and stability. The snRNA-seq analysis of the cortex showed that the adaptation to RH involved different biological processes from those seen in the hypothalamus. CONCLUSIONS/INTERPRETATION The present study provides a model of defective counterregulation in a mouse model of type 2 diabetes. It shows that repeated hypoglycaemic episodes induce multiple defects affecting all hypothalamic cell types and their interactions, indicative of impaired neuronal network signalling and dysegulated hypoglycaemia sensing, and displaying features of neurodegenerative diseases. It also shows that repeated hypoglycaemia leads to specific molecular adaptation in the hypothalamus when compared with the cortex. DATA AVAILABILITY The transcriptomic dataset is available via the GEO ( http://www.ncbi.nlm.nih.gov/geo/ ), using the accession no. GSE226277. The proteomic dataset is available via the ProteomeXchange data repository ( http://www.proteomexchange.org ), using the accession no. PXD040183.
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Affiliation(s)
- Judit Castillo-Armengol
- Novo Nordisk A/S, Måløv, Denmark
- Center for Integrative Genomics (CIG), University of Lausanne, Lausanne, Switzerland
| | - Flavia Marzetta
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | | | - Mark Evans
- IMS Metabolic Research Laboratories, Addenbrookes Biomedical Campus, Cambridge, UK
| | | | | | - Mark Ibberson
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Bernard Thorens
- Center for Integrative Genomics (CIG), University of Lausanne, Lausanne, Switzerland.
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.
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Matthews A, Timothy K, Golden A, Gonzalez Corcia MC. International Cohort of Neonatal Timothy Syndrome. Neonatology 2024:1-8. [PMID: 38211567 DOI: 10.1159/000535221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Timothy syndrome (TS) is an extremely rare, multisystem disorder classically associated with long QT, syndactyly, ventricular arrhythmias, and hypoglycaemia. A neonatal diagnosis allows maximal medical and device therapy to be implemented to avoid malignant arrhythmias and sudden cardiac death. METHODS This was a retrospective case series study of type I TS (TS1) patients using data from the Timothy Syndrome Foundation's international registry, encompassing patients with a genetic diagnosis (CACNA1C variant G406R in exon 8A) recruited over a 28-year period. RESULTS Forty-four cases of TS1 were included (26 male; 60%). Mean gestational age (GA) was 35.6 weeks (range 28 weeks - term), with 43% of patients born less than 37 weeks GA. In TS1 patients presenting with foetal bradycardia, mean GA was significantly lower (34.2 weeks, p < 0.05). Foetal bradycardia secondary to atrioventricular block was present in 20 patients (45%), resulting in premature delivery in 14 patients (32%). Fifteen patients (34%) were diagnosed with TS1 as neonates. Long QT at birth helped secure a diagnosis in 25 patients (57%). Syndactyly was seen in most patients (n = 40, 91%). Twenty patients died, with an average age of death of 2.3 years (range 1 month-6 years). Of the 7 patients who died before the first year of life (16%), the average age of death was 2.5 months. CONCLUSION TS is associated with high early mortality. TS should be considered in paediatric patients presenting with long QT and syndactyly. Recognition of TS in the neonatal period allows for early intervention to prevent life-threatening arrhythmias.
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Affiliation(s)
- Alexandra Matthews
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, London, UK
| | - Katherine Timothy
- The Timothy Syndrome Foundation, Charitable Organization, Ellicott City, Maryland, USA
| | - Andy Golden
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA
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Awasthi R, Pande AK, Chandra KP, Agarwal V, Gupta M, Tewari A, Gupta N, Chaubey S, Chaudhary S, Ansari S, Kumar D. Screening of Individuals with Type 2 Diabetes on Anti-Diabetic Agents for Probable Hypoglycaemia Using the Stanford Hypoglycemia Questionnaire (SHQ) in Outpatient Settings: A Cross-Sectional Study from Outpatient Diabetes Care Centres in North India. Indian J Endocrinol Metab 2024; 28:86-90. [PMID: 38533289 PMCID: PMC10962778 DOI: 10.4103/ijem.ijem_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations. Methods It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG). Results This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P = <0.001), retinopathy (P = <0.001) and nephropathy (P = <0.001) had significantly higher SHQ scores. Insulin or SU use was associated with a significantly higher SHQ score. Concomitant statin use was associated with a lower incidence of mild, moderate and severe hypoglycaemia (P = 0.01). On multivariate analysis, we found that age, sex, systolic blood pressure (SBP), insulin use and fasting blood sugar were the most important factors associated with an increased risk of hypoglycaemia with an R2 cut-off of 0.7. Conclusion SHQ was discovered to be a simple and cost-effective screening tool for outpatient detection of hypoglycaemia in an Indian setting, and it can add value to management.
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Affiliation(s)
- Rajiv Awasthi
- Internal Medicine, Prarthana Clinic and Diabetes Care Centre, Lucknow, Uttar Pradesh, India
| | - Arun K. Pande
- Endocrinology, Lucknow Endocrine Diabetes and Thyroid Clinic, Lucknow, Uttar Pradesh, India
| | - Kumar P. Chandra
- Diabetology, Chandra Diabetes Clinic, Lucknow, Uttar Pradesh, India
| | - Vivek Agarwal
- Internal Medicine RR Diabetes and Heart Care Centre, Lucknow, Uttar Pradesh, India
| | - Mukulesh Gupta
- Internal Medicine ,Udyaan Healthcare, Lucknow, Uttar Pradesh, India
| | - Ajoy Tewari
- Internal Medicine, Jai Clinic and Diabetes Care Centre, Lucknow, Uttar Pradesh, India
| | - Nitin Gupta
- Internal Medicine Lucknow Hormone Centre, Lucknow, Uttar Pradesh, India
| | - Santosh Chaubey
- Endocrinology, Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
| | | | - Sajid Ansari
- Internal Medicine, SS Heart Care Centre, Lucknow, Uttar Pradesh, India
| | - Dinesh Kumar
- Internal Medicine, Harsh Clinic and Diabetes Care Centre, Lucknow, Uttar Pradesh, India
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Maharjan J, Pandit S, Arne Johansson K, Khanal P, Karmacharya B, Kaur G, Kumar Aryal K. Effectiveness of interventions for emergency care of hypoglycaemia and diabetic ketoacidosis: A systematic review. Diabetes Res Clin Pract 2024; 207:111078. [PMID: 38154537 DOI: 10.1016/j.diabres.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
AIM This systematic review aims to provide evidence on effectiveness of interventions used in emergency care of hypoglycaemia and diabetic ketoacidosis (DKA). METHODOLOGY This is a systematic review of randomized controlled trials and analytical studies. We selected studies based on eligibility criteria. The databases Medline, Cochrane library and Embase were searched from their inception till November 2, 2022, using search strategy. We used the term such as "diabetes mellitus", "treatment", "hypoglycaemia", "diabetic ketoacidosis", "low blood sugar", "high blood sugar" and Mesh terms like "disease management", "hypoglycaemia", "diabetic ketoacidosis", and "diabetes mellitus" to form search strategy. RESULTS Hypoglycemia: Both 10 % dextrose (D10) and 50 % dextrose (D50) are effective options with similar hospital mortality D10 (4.7 %) and D50 (6.2 %). DKA: Low dose insulin is non-inferior to standard dose with time till resolution of DKA 16.5 (7.2) hours and 17.2 (7.7) hours (p value = 0.73) respectively. In children, subcutaneous insulin was associated with reduced ICU admissions and hospital readmissions (67.8 % to 27.9 %). Plasmalyte (PL) is noninferior to sodium chloride (SC), with ICU length of stay 49 h (IQR 23-72) and 55 h (IQR 41-80) respectively, hyperchloremia was associated with longer in-hospital length of stay and longer time to resolution of DKA. And potassium replacement at < 10 mmol/L was associated with higher mortality (n = 72). CONCLUSION We conclude either of the 10 % or 50 % dextrose is effective for management of hypoglycaemia. For DKA subcutaneous insulin and intravenous insulin, chloride levels ≤ 109 mEq/L, potassium above 10 mmol/l, IV fluids like Plasmalyte and normal saline are effective.
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Affiliation(s)
- Jasmine Maharjan
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway.
| | - Sagar Pandit
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Pratik Khanal
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Biraj Karmacharya
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway; Kathmandu University, School of Medical Sciences, Kathmandu University, Nepal
| | - Gunjeet Kaur
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Norway
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Jalleh RJ, Umapathysivam MM, Plummer MP, Deane A, Jones KL, Horowitz M. Postprandial plasma GLP-1 levels are elevated in individuals with postprandial hypoglycaemia following Roux-en-Y gastric bypass - a systematic review. Rev Endocr Metab Disord 2023; 24:1075-1088. [PMID: 37439960 PMCID: PMC10697890 DOI: 10.1007/s11154-023-09823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND AIMS Bariatric surgery is the most effective treatment in individuals with obesity to achieve remission of type 2 diabetes. Post-bariatric surgery hypoglycaemia occurs frequently, and management remains suboptimal, because of a poor understanding of the underlying pathophysiology. The glucoregulatory hormone responses to nutrients in individuals with and without post-bariatric surgery hypoglycaemia have not been systematically examined. MATERIALS AND METHODS The study protocol was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science and the Cochrane databases were searched for publications between January 1990 and November 2021 using MeSH terms related to post-bariatric surgery hypoglycaemia. Studies were included if they evaluated individuals with post-bariatric surgery hypoglycaemia and included measurements of plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide and/or glucagon concentrations following an ingested nutrient load. Glycated haemoglobin (HbA1c) was also evaluated. A random-effects meta-analysis was performed, and Hedges' g (standardised mean difference) and 95% confidence intervals were reported for all outcomes where sufficient studies were available. The τ2 estimate and I2 statistic were used as tests for heterogeneity and a funnel plot with the Egger regression-based test was used to evaluate for publication bias. RESULTS From 377 identified publications, 12 were included in the analysis. In all 12 studies, the type of bariatric surgery was Roux-en-Y gastric bypass (RYGB). Comparing individuals with and without post-bariatric surgery hypoglycaemia following an ingested nutrient load, the standardised mean difference in peak GLP-1 was 0.57 (95% CI, 0.32, 0.82), peak GIP 0.05 (-0.26, 0.36), peak insulin 0.84 (0.44, 1.23), peak C-peptide 0.69 (0.28, 1.1) and peak glucagon 0.05 (-0.26, 0.36). HbA1c was less in individuals with hypoglycaemia - 0.40 (-0.67, -0.12). There was no evidence of substantial heterogeneity in any outcome except for peak insulin: τ2 = 0.2, I2 = 54.3. No publication bias was evident. CONCLUSION Following RYGB, postprandial peak plasma GLP-1, insulin and C-peptide concentrations are greater in individuals with post-bariatric surgery hypoglycaemia, while HbA1c is less. These observations support the concept that antagonism of GLP-1 would prove beneficial in the management of individuals with hypoglycaemia following RYGB.PROSPERO Registration Number: CRD42021287515.
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Affiliation(s)
- Ryan Joseph Jalleh
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, South Australia, Australia
- Diabetes and Endocrine Services, Northern Adelaide Local Health Network, South Australia, Australia
| | - Mahesh Michael Umapathysivam
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, South Australia, Australia
| | - Mark Philip Plummer
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
| | - Adam Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Karen Louise Jones
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, South Australia, Australia
| | - Michael Horowitz
- Adelaide Medical School, The University of Adelaide, South Australia, Australia.
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, South Australia, Australia.
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Dolenc Šparovec E, Slabe D, Eržen I, Kovačič U. Evaluation of a newly developed first aid training programme adapted for older people. BMC Emerg Med 2023; 23:134. [PMID: 37950197 PMCID: PMC10636823 DOI: 10.1186/s12873-023-00907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Older people need to acquire knowledge and skills at first aid (FA) training tailored to them. Our research aimed to evaluate an FA training programme adapted for older people. We assumed that satisfaction with FA training, as well as knowledge of FA, would be higher among older people who received training according to an adapted programme compared to those who received training according to the existing programme for the general public. METHODS We trained older people according to the existing FA programme for the general public and according to a new FA training programme adapted for older people. The new training program is shorter and focuses on FA contents that are more relevant for older people. We evaluated participants with a general assessment questionnaire (consisting of items regarding satisfaction, comprehensibility, length, and physical difficulty), a test on theoretical FA knowledge, and a test on practical cardiopulmonary resuscitation (CPR) knowledge. To ensure the homogeneity of the groups and to verify the impact on the results of the test of practical CPR knowledge, we also tested the participants regarding their psychophysical capabilities. RESULTS A total of 120 people completed the free FA training sessions. The general assessment questionnaire score of participants who were trained based on the new FA training program was 19.3 (out of 20), which was statistically significantly (p < 0.05) higher than that of those trained based on the old program (general assessment score of 17.1). Participants who were trained based on the new program scored an average of 8.6 points on the theoretical FA knowledge test, while those who were trained based on the old program scored an average of 7.1 points, which was statistically significantly (p < 0.05) lower. In both programs, the same average scores (7.5 out of 10 points) on the practical CPR knowledge test was achieved. However, participants who participated in the FA course adapted for the older people gained practical CPR knowledge in a shorter time. Older people with a greater psychophysical capacity were more successful in performing CPR, regardless of which FA training programme they received. CONCLUSIONS The effectiveness of FA training is greater if older people are trained in accordance with a targeted programme adapted to the psychophysical limitations of the older people.
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Affiliation(s)
- Eva Dolenc Šparovec
- Faculty of Health Sciences, Sanitary Engineering Department, Public Health Division, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia.
| | - Damjan Slabe
- Faculty of Health Sciences, Sanitary Engineering Department, Public Health Division, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia
| | - Ivan Eržen
- Faculty of Health Sciences, Sanitary Engineering Department, Public Health Division, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia
| | - Uroš Kovačič
- Faculty of Health Sciences, Sanitary Engineering Department, Public Health Division, University of Ljubljana, Zdravstvena pot 5, Ljubljana, 1000, Slovenia
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Chatwin H, Broadley M, Hendrieckx C, Carlton J, Heller S, Amiel SA, de Galan B, McCrimmon RJ, Pedersen-Bjergaard U, Pouwer F, Speight J. The impact of hypoglycaemia on quality of life among adults with type 1 diabetes: Results from "YourSAY: Hypoglycaemia". J Diabetes Complications 2023; 37:108232. [PMID: 35927177 DOI: 10.1016/j.jdiacomp.2022.108232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
AIMS Research on hypoglycaemia and quality of life (QoL) has focused mostly on severe hypoglycaemia and psychological outcomes, with less known about other aspects of hypoglycaemia (e.g., self-treated episodes) and impacts on other QoL domains (e.g., relationships). Therefore, we examined the impact of all aspects of hypoglycaemia on QoL in adults with type 1 diabetes (T1DM). METHODS Participants completed an online survey, including assessment of hypoglycaemia-specific QoL (using the 12-item Hypoglycaemia Impact Profile). Mann-Whitney U tests examined differences in hypoglycaemia-specific QoL by hypoglycaemia frequency, severity, and awareness. Hierarchical linear regression examined associations with QoL. RESULTS Participants were 1028 adults with T1DM (M ± SD age: 47 ± 15 years; diabetes duration: 27 ± 16 years). Severe and self-treated hypoglycaemia and impaired awareness negatively impacted on overall QoL and several QoL domains, including leisure activities, physical health, ability to keep fit/be active, sleep, emotional well-being, spontaneity, independence, work/studies, and dietary freedom. Diabetes distress was most strongly associated with hypoglycaemia-specific QoL, followed by generic emotional well-being, fear of hypoglycaemia, and confidence in managing hypoglycaemia. Hypoglycaemia frequency and awareness were no longer significantly associated with QoL once psychological factors were considered. CONCLUSIONS Hypoglycaemia negatively impacts on several QoL domains. Psychological factors supersede the effect of hypoglycaemia frequency and awareness in accounting for this negative impact.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark; National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark.
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jill Carlton
- School of Health Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Stephanie A Amiel
- Department of Diabetes, King's College London, London, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands; Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; Steno Diabetes Center Odense, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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Lord LG, Harding JE, Crowther CA, Lin L. Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:744. [PMID: 37865757 PMCID: PMC10590034 DOI: 10.1186/s12884-023-06057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this. METHODS Published randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case-control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12th, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322). RESULTS This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case-control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I2 = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25-1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I2 = 90%, p for Egger's test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain. CONCLUSION Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.
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Affiliation(s)
- Libby G Lord
- Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Caroline A Crowther
- Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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Fløde M, Hermann M, Haugstvedt A, Søfteland E, Igland J, Åsberg A, Jenssen TG, Graue M. High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway. BMC Endocr Disord 2023; 23:218. [PMID: 37817166 PMCID: PMC10566065 DOI: 10.1186/s12902-023-01472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND A scoping review from 2021 identified a lack of studies on the incidence, prevention and management of hypoglycaemia in home-dwelling older people with diabetes. The aim of this study was to investigate the frequency and duration of hypoglycaemic episodes measured by continuous glucose monitoring (CGM) in older people with diabetes who received home care and who were treated with glucose-lowering medications, and to compare the frequency and duration of hypoglycaemic episodes between subgroups of the study population according to demographic and clinical variables. METHODS This was an observational study investigating the occurrence of hypoglycaemia in people with diabetes aged ≥ 65 years. Data were collected using blinded continuous glucose monitoring (CGM, iPro2) for 5 consecutive days. Frequency and duration of hypoglycaemic episodes were assessed using a sensor glucose cut-off value of 3.9 mmol/L. A blood sample for measurement of HbA1c and creatinine-based eGFR (CKD-EPI) was obtained during the monitoring period. Demographic and clinical data were collected from electronic patient records. RESULTS Fifty-six individuals were enrolled (median age 82 years and 52% were men). Of the 36 participants who were treated with insulin, 33% had at least one hypoglycaemic episode during the five-day period. Among 18 participants who neither used insulin nor sulfonylurea, but other glucose-lowering medications, 44% had at least one hypoglycaemicepisode. Of those with hypoglycaemic episodes, 86% lived alone. The median duration of the hypoglycaemia was 1 h and 25 min, ranging from 15 min to 8 h and 50 min. CONCLUSION This study identified an unacceptably high number of unknown hypoglycaemic episodes among older home-dwelling people with diabetes receiving home care, even among those not using insulin or sulfonylurea. The study provides essential knowledge that can serve as a foundation to improve the treatment and care for this vulnerable patient group. The routines for glucose monitoring and other prevention tasks need to be considered more comprehensively, also, among those treated with glucose-lowering medications other than insulin.
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Affiliation(s)
- Mari Fløde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Monica Hermann
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - Trond Geir Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
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Kosjerina V, Carstensen B, Amadid H, Vistisen D. Glycaemic control, risk of hypoglycaemia and all-cause mortality in new users of second-generation basal insulin with type 2 diabetes and chronic kidney disease: a nationwide register-based cohort study. Diabetologia 2023; 66:1908-1913. [PMID: 37505281 DOI: 10.1007/s00125-023-05971-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare the performance of the second-generation basal insulins, insulin degludec 100 U/ml (Deg-100) and insulin glargine 300 U/ml (Gla-300), in terms of change in HbA1c, hospitalisation for hypoglycaemia and all-cause mortality among individuals with type 2 diabetes and concurrent chronic kidney disease. METHODS This register-based cohort study, based on the entire Danish diabetes population, included 6519 new users of Deg-100 and Gla-300 with type 2 diabetes and moderate to end-stage chronic kidney disease. HbA1c trajectories, from initiation of either Deg-100 (2013) or Gla-300 (2015) to end of follow-up (2020), were modelled with mixed-effect models while rates of hospitalisation for hypoglycaemia and all-cause mortality were modelled in separate models using Poisson likelihood. RESULTS Of the 6519 (44% women) individuals included in the study, 3747 were exposed to Deg-100 and 2772 to Gla-300. Both mean (SD) type 2 diabetes duration (14.4 [6.6] years vs 15.2 [6.7] years) and median (IQR) chronic kidney disease duration (2.3 [1.3, 3.9] years vs 2.8 [1.6, 4.6] years) were significantly shorter in the Gla-300 group. The median (IQR) follow-up time was similar between groups: 1.0 (0.5-1.6) year for Gla-300 and 1.0 (0.3-1.5) year for Deg-100. In both groups mean HbA1c levels were reduced by 13-14 mmol/mol (1.2-1.3%) from initiation to end of follow-up, with the largest reduction (of 8-9 mmol/mol [0.7-0.8%]) occurring during the first year. There was no significant difference in HbA1c reduction between Deg-100 and Gla-300. Both the rate of hospitalisation for hypoglycaemia (rate ratio 1.02 [95% CI 0.70, 1.49], Deg-100 vs Gla-300) and the rate of all-cause mortality (rate ratio 0.98 [95% CI 0.84, 1.15], Deg-100 vs Gla-300) were similar between the groups. CONCLUSIONS/INTERPRETATION We found no difference in HbA1c reduction, hospitalisation for hypoglycaemia or all-cause mortality between Gla-300 and Deg-100 in a real-world population of new users with type 2 diabetes and moderate to end-stage chronic kidney disease. Therefore, we conclude that these two treatment options are equally effective and safe in this vulnerable population.
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Affiliation(s)
- Vanja Kosjerina
- Steno Diabetes Center Copenhagen, Herlev, Denmark.
- Department of Endocrinology, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | | | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Herlev, Denmark
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Dutta D, Nagendra L, Bhat S, Mohindra R, Surana V, Misra A. Optimal use of once weekly icodec insulin in type-2 diabetes: An updated meta-analysis of phase-2 and phase-3 randomized controlled trials. Diabetes Metab Syndr 2023; 17:102877. [PMID: 37832481 DOI: 10.1016/j.dsx.2023.102877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Previously published meta-analysis have analysed data from 3 small phase-2 randomized controlled trials (RCTs). Since then, 5 big phase-3 RCTs have been published on use of icodec in type-2 diabetes (T2D). This updated systematic review aimed to establish the best practices and safety of icodec in T2D. METHODS Databases were searched for RCTs involving T2D patients receiving icodec. Primary outcome was change in HbA1c. Secondary outcomes were alterations in glycaemic parameters and adverse events. RESULTS Data from 8 studies (4317 patients) was analysed. Compared to other basal insulins, icodec had comparable HbA1c lowering at 16-weeks [MD-0.19 %(95%CI: 0.58-0.20); P = 0.35; I2 = 92 %], better HbA1c lowering at 26-weeks [MD-0.19 %(95%CI: 0.35-0.013); P = 0.02; I2 = 94 %] and 52-weeks [MD -0.28 %(95%CI: 0.45-0.12); P = 0.0008; I2 = 100 %]. Percentage of participants achieving HbA1c<7 % with icodec was higher at 16-weeks [OR2.37(95%CI:1.05-5.35); P = 0.04], comparable at 26-weeks [OR1.38(95%CI:0.91-2.11); P = 0.13; I2 = 80 %], and higher at 52-weeks [OR1.55(95%CI:1.30-1.85); P < 0.00001; I2 = 0 %]. Percentage of participants achieving HbA1c<7 % without level 2/3 hypoglycaemia was higher with icodec at 26-weeks [OR1.37(95%CI:1.10-1.71); P = 0.004; I2 = 28 %] and 52-weeks [OR1.48(95%CI:1.24-1.77); P < 0.001; I2 = 0 %]. At 26-weeks, injection-site reactions was higher with icodec [OR1.95(95%CI:1.06-3.56); P = 0.03; I2 = 0 %]. At 26-weeks level-1 hypoglycemia [OR1.40(95%CI:1.02-1.94); P = 0.04; I2 = 58 %], but not level-2/3 hypoglycaemia was higher with icodec. Subset analysis revealed increased occurrence of level-1 [OR 4.19 (95 % CI: 3.20-5.50); P < 0.00001] and level-2 [OR 3.97 (95 % CI: 3.04-5.18); P < 0.00001] hypoglycaemia in participants who received one-time additional 50 % icodec loading dose as compared to those who did not. At 26-weeks, weight-gain was significantly higher with icodec [MD0.61 kg(95%CI:0.38-0.84); P < 0.00001; I2 = 98 %]. CONCLUSION Icodec insulin is well tolerated with glycaemic efficacy similar to all other available basal insulins.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.
| | - Sowrabha Bhat
- Department of Endocrinology, Yenepoya Medical College, Mangalore, India.
| | - Ritin Mohindra
- Department of Medicine, Post-Graduate Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vineet Surana
- Department of Endocrinology, Manipal Hospitals, New Delhi, India.
| | - Anoop Misra
- Department of Endocrinology, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India.
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Godoi A, Reis Marques I, Padrão EMH, Mahesh A, Hespanhol LC, Riceto Loyola Júnior JE, de Souza IAF, Moreira VCS, Silva CH, Miyawaki IA, Oommen C, Gomes C, Silva AC, Advani K, de Sa JR. Glucose control and psychosocial outcomes with use of automated insulin delivery for 12 to 96 weeks in type 1 diabetes: a meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2023; 15:190. [PMID: 37759290 PMCID: PMC10537468 DOI: 10.1186/s13098-023-01144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Glycaemic control of Type 1 Diabetes Mellitus (T1DM) remains a challenge due to hypoglycaemic episodes and the burden of insulin self-management. Advancements have been made with the development of automated insulin delivery (AID) devices, yet, previous reviews have only assessed the use of AID over days or weeks, and potential benefits with longer time of AID use in this population remain unclear. METHODS We performed a systematic review and meta-analysis of randomised controlled trials comparing AID (hybrid and fully closed-loop systems) to usual care (sensor augmented pumps, multiple daily insulin injections, continuous glucose monitoring and predictive low-glucose suspend) for adults and children with T1DM with a minimum duration of 3 months. We searched PubMed, Embase, Cochrane Central, and Clinicaltrials.gov for studies published up until April 4, 2023. Main outcomes included time in range 70-180 mg/dL as the primary outcome, and change in HbA1c (%, mmol/mol), glucose variability, and psychosocial impact (diabetes distress, treatment satisfaction and fear of hypoglycaemia) as secondary outcomes. Adverse events included diabetic ketoacidosis (DKA) and severe hypoglycaemia. Statistical analyses were conducted using mean differences and odds ratios. Sensitivity analyses were performed according to age, study duration and type of AID device. The protocol was registered in PROSPERO, CRD42022366710. RESULTS We identified 25 comparisons from 22 studies (six crossover and 16 parallel designs) including a total of 2376 participants (721 in adult studies, 621 in paediatric studies, and 1034 in combined studies) which were eligible for analysis. Use of AID devices ranged from 12 to 96 weeks. Patients using AID had 10.87% higher time in range [95% CI 9.38 to 12.37; p < 0.0001, I2 = 87%) and 0.37% (4.77 mmol/mol) lower HbA1c (95% CI - 0.49% (- 6.39 mmol/mol) to - 0.26 (- 3.14 mmol/mol); p < 0·0001, I2 = 77%]. AID systems decreased night hypoglycaemia, time in hypoglycaemia and hyperglycaemia and improved patient distress, with no increase in the risk of DKA or severe hypoglycaemia. No difference was found regarding treatment satisfaction or fear of hypoglycaemia. Among children, there was no difference in glucose variability or time spent in hypoglycaemia between the use of AID systems or usual care. In sensitivity analyses, results remained consistent with the overall analysis favouring AID. CONCLUSION The use of AID systems over 12 weeks, regardless of technical or clinical differences, improved glycaemic outcomes and diabetes distress without increasing the risk of adverse events in adults and children with T1DM.
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Affiliation(s)
- Amanda Godoi
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF144YS, UK.
| | | | | | | | | | | | | | | | | | | | | | - Cintia Gomes
- Federal University of Santa Maria, Santa Maria, Brazil
| | - Ariadne C Silva
- UniEvangelica University Centre of Anapolis, Anapolis, Brazil
| | | | - Joao Roberto de Sa
- Endocrinology Division, ABC School of Medicine and Federal University of Sao Paulo, Paulista School of Medicine, São Paulo, Brazil
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Repetto P, Ayago D. Clinical impact after implementing an insulin protocol involving a switch to insulin glargine 300 U/ml as basal insulin for inpatient glycaemic control: A retrospective single-centre study. J Diabetes Complications 2023; 37:108584. [PMID: 37595369 DOI: 10.1016/j.jdiacomp.2023.108584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
AIMS To evaluate the benefit and safety of a switch in the basal insulin protocol to glargine 300 U/ml (Gla-300) on inpatients' overall dysglycemic events. Efficacy and safety data on insulin Gla-300 in the inpatient setting are limited. METHODS Retrospective observational study conducted on 7455 patients admitted to acute care (n = 5414) or geriatric and social healthcare (n = 2041) units of the Regional Hospital of Amposta (Spain) between January 2017 and December 2020 who received basal insulin during hospitalization. Hypo- and hyperglycaemic events were indirectly assessed through hospital pharmacy usage of intravenous glucose and vials of rapid-acting intravenous insulin for 27 months after the switch, and the impact on overall dysglycemic events was analysed. RESULTS After protocol implementation, patients were mostly treated with Gla-300 (83.06 % in acute care; and 83.44 % in geriatric and social healthcare), and presented a significant decrease in the use of intravenous insulin (-60.80 %, P = 0.005) and glucose (-62.13 %, P < 0.001), which translated into a significantly reduced overall dysglycemic events (-62.25 %, P < 0.001), with a good safety and tolerability profile. CONCLUSIONS Overall inpatient dysglycemic events were improved upon the introduction of the new insulin protocol, which calls for the use of Gla-300 as one of the choices of basal insulin for inpatient care.
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Affiliation(s)
- Pablo Repetto
- Servicio de Medicina Interna, Hospital Comarcal de Amposta, Tarragona, Spain.
| | - Daria Ayago
- Servicio de Farmacia, Hospital Comarcal de Amposta, Tarragona, Spain
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22
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Stimson RH, Dover AR, Strachan MWJ, Wright RJ, Lyall MJ, Jeeyavudeen MS, Forbes S, Gibb FW. Associations between glucagon prescribing, hospital admissions for hypoglycaemia and continuous glucose monitoring metrics in adults with type 1 diabetes. J Diabetes Complications 2023; 37:108561. [PMID: 37499292 DOI: 10.1016/j.jdiacomp.2023.108561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
AIMS To assess features associated with glucagon prescribing and hospital admissions with hypoglycaemia in type one diabetes. METHODS Observational study of 4462 adults. Outcome measures were features associated with glucagon prescriptions and predictors of hospital admissions with hypoglycaemia and high levels of glucagon prescribing. RESULTS 74 % did not collect any glucagon prescriptions and 2.7 % collected >6 over 3.5 years. Hospital admission with hypoglycaemia (P = 0.032), impaired awareness (P = 0.049) and female sex (P < 0.001) were associated with glucagon collection. More frequent prescribing of glucagon was associated with diabetes duration (P < 0.001) and socioeconomic deprivation (P < 0.001). Higher average glucose (P = 0.047), higher time above 13.9 mM (P = 0.008) and higher SD (P = 0.002) were associated with glucagon prescribing. Diabetes duration (P < 0.001) and HbA1c (P < 0.001) were higher in people with hospitalised hypoglycaemia. Higher time above 13.9 mM (P = 0.004) and SD glucose (P < 0.001) were most clearly associated with hospitalised hypoglycaemia. CONCLUSIONS A minority of people with type 1 diabetes have access to glucagon suggesting more could be done to better target this treatment. Individuals with risk factors and those with frequent glucagon prescriptions should be identified for interventions known to reduce hypoglycaemia.
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Affiliation(s)
- Roland H Stimson
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK
| | - Rohana J Wright
- Edinburgh Centre for Endocrinology & Diabetes, St John's Hospital, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mohammad S Jeeyavudeen
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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23
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Talbo MK, Katz A, Hill L, Peters TM, Yale JF, Brazeau AS. Effect of diabetes technologies on the fear of hypoglycaemia among people living with type 1 diabetes: a systematic review and meta-analysis. EClinicalMedicine 2023; 62:102119. [PMID: 37593226 PMCID: PMC10430205 DOI: 10.1016/j.eclinm.2023.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
Background Fear of hypoglycaemia (FOH) significantly disrupts the daily management of type 1 diabetes (T1D) and increases the risk of complications. Recent technological advances can improve glucose metrics and reduce hypoglycaemia frequency, yet their impact on FOH is unclear. This systematic review and meta-analysis (SRMA) aimed to synthesize the current literature to understand the impact of diabetes technologies on FOH in T1D. Methods In this SRMA, we searched PubMed, Medline, Scopus, and Web of Science from inception up to May 21st, 2023 for studies assessing the effect of using real-time or intermittently scanned continuous glucose monitors (rtCGM or isCGM); insulin pumps (CSII); and their combinations on FOH as the primary outcome, measured using the Hypoglycaemia Fear Survey (HFS; including total, worries [HFS-W], and behaviours [HFS-B] scores), in non-pregnant adults with T1D. Data was extracted by the first and second authors. Results were pooled using a random-effects model based on study design (RCT and non-RCT), with subgroup analysis based on the type of technology, reported change in hypoglycaemia frequency, and duration of use. Risk of bias was evaluated with Cochrane and Joanna Briggs Institute tools. This study is registered with PROSPERO, CRD42021253618. Findings A total of 51 studies (n = 8966) were included, 22 of which were RCTs. Studies on rtCGM and CSII reported lower FOH levels with ≥8 weeks of use. Studies on CSII and rtCGM combinations reported lower FOH levels after ≥13 weeks of automated insulin delivery (AID) use or 26 weeks of sensor-augmented pump (SAP) use. The meta-analysis showed an overall lower FOH with technologies, specifically for the HFS-W subscale. The RCT meta-analysis showed lower HFS-W scores with rtCGM use (standard mean difference [95%CI]: -0.14 [-0.23, -0.05], I2 = 0%) and AID (-0.17 [-0.33, -0.01], I2 = 0%). Results from non-RCT studies show that SAP users (-0.33 [-0.38, -0.27], I2 = 0%) and rtCGM users (-0.38 [-0.61, -0.14], I2 = 0%) had lower HFS-W. Interpretation We found consistent, yet small to moderate, effects supporting that diabetes technologies (specifically rtCGM, SAP, and AID) may reduce hypoglycaemia-related worries in adults with T1D. Current literature, however, has limitations including discrepancies in baseline characteristics and limited, mainly descriptive, statistical analysis. Thus, future studies should assess FOH as a primary outcome, use validated surveys, and appropriate statistical analysis to evaluate the clinical impacts of technology use beyond just glucose metrics. Funding Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation Ltd.
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Affiliation(s)
- Meryem K. Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Québec H9X 3V9, Canada
| | - Alexandra Katz
- School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Québec H9X 3V9, Canada
- Faculté de Médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada
| | - Lee Hill
- School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Québec H9X 3V9, Canada
- Department of Paediatrics, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Boulevard W, Montréal, Québec H4A 3S9, Canada
| | - Tricia M. Peters
- Centre for Clinical Epidemiology, and Division of Endocrinology, Lady Davis Research Institute, Jewish General Hospital, 3755 Cote Ste Catherine, Montréal, Québec H3T 1E2, Canada
| | - Jean-François Yale
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, 687 Pine Avenue West Montreal, Montréal, Québec H3A 1A1, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, Québec H9X 3V9, Canada
- Montréal Diabetes Research Centre, 900, Saint-Denis, Montréal, Québec H2X 0A9, Canada
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Pieber TR, Arfelt KN, Cailleteau R, Hart M, Kar S, Mursic I, Svehlikova E, Urschitz M, Haahr H. Hypoglycaemia frequency and physiological response after double or triple doses of once-weekly insulin icodec vs once-daily insulin glargine U100 in type 2 diabetes: a randomised crossover trial. Diabetologia 2023; 66:1413-1430. [PMID: 37308751 PMCID: PMC10317887 DOI: 10.1007/s00125-023-05921-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/07/2023] [Indexed: 06/14/2023]
Abstract
AIMS/HYPOTHESIS This study compared the frequency of hypoglycaemia, time to hypoglycaemia and recovery from hypoglycaemia after double or triple doses of once-weekly insulin icodec vs once-daily insulin glargine U100. Furthermore, the symptomatic and counterregulatory responses to hypoglycaemia were compared between icodec and glargine U100 treatment. METHODS In a randomised, single-centre (Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria), open-label, two-period crossover trial, individuals with type 2 diabetes (age 18-72 years, BMI 18.5-37.9 kg/m2, HbA1c ≤75 mmol/mol [≤9.0%]) treated with basal insulin with or without oral glucose-lowering drugs received once-weekly icodec (for 6 weeks) and once-daily glargine U100 (for 11 days). Total weekly doses were equimolar based on individual titration of daily glargine U100 during the run-in period (target fasting plasma glucose [PG]: 4.4-7.2 mmol/l). Randomisation was carried out by assigning a randomisation number to each participant in ascending order, which encoded to one of two treatment sequences via a randomisation list prepared prior to the start of the trial. At steady state, double and triple doses of icodec and glargine U100 were administered followed by hypoglycaemia induction: first, euglycaemia was maintained at 5.5 mmol/l by variable i.v. infusion of glucose; glucose infusion was then terminated, allowing PG to decrease to no less than 2.5 mmol/l (target PGnadir). The PGnadir was maintained for 15 min. Euglycaemia was restored by constant i.v. glucose (5.5 mg kg-1 min-1). Hypoglycaemic symptoms score (HSS), counterregulatory hormones, vital signs and cognitive function were assessed at predefined PG levels towards the PGnadir. RESULTS Hypoglycaemia induction was initiated in 43 and 42 participants after double dose of icodec and glargine U100, respectively, and in 38 and 40 participants after triple doses, respectively. Clinically significant hypoglycaemia, defined as PGnadir <3.0 mmol/l, occurred in comparable proportions of individuals treated with icodec vs glargine U100 after double (17 [39.5%] vs 15 [35.7%]; p=0.63) and triple (20 [52.6%] vs 28 [70.0%]; p=0.14) doses. No statistically significant treatment differences were observed in the time to decline from PG values of 5.5 mmol/l to 3.0 mmol/l (2.9-4.5 h after double dose and 2.2-2.4 h after triple dose of the insulin products). The proportion of participants with PGnadir ≤2.5 mmol/l was comparable between treatments after double dose (2 [4.7%] for icodec vs 3 [7.1%] for glargine U100; p=0.63) but higher for glargine U100 after triple dose (1 [2.6%] vs 10 [25.0%]; p=0.03). Recovery from hypoglycaemia by constant i.v. glucose infusion took <30 min for all treatments. Analyses of the physiological response to hypoglycaemia only included data from participants with PGnadir <3.0 mmol/l and/or the presence of hypoglycaemic symptoms; in total 20 (46.5%) and 19 (45.2%) individuals were included after a double dose of icodec and glargine U100, respectively, and 20 (52.6%) and 29 (72.5%) individuals were included after a triple dose of icodec and glargine U100, respectively. All counterregulatory hormones (glucagon, adrenaline [epinephrine], noradrenaline [norepinephrine], cortisol and growth hormone) increased during hypoglycaemia induction with both insulin products at both doses. Following triple doses, the hormone response was greater with icodec vs glargine U100 for adrenaline at PG3.0 mmol/l (treatment ratio 2.54 [95% CI 1.69, 3.82]; p<0.001), and cortisol at PG3.0 mmol/l (treatment ratio 1.64 [95% CI 1.13, 2.38]; p=0.01) and PGnadir (treatment ratio 1.80 [95% CI 1.09, 2.97]; p=0.02). There were no statistically significant treatment differences in the HSS, vital signs and cognitive function. CONCLUSIONS/INTERPRETATION Double or triple doses of once-weekly icodec lead to a similar risk of hypoglycaemia compared with double or triple doses of once-daily glargine U100. During hypoglycaemia, comparable symptomatic and moderately greater endocrine responses are elicited by icodec vs glargine U100. TRIAL REGISTRATION ClinicalTrials.gov NCT03945656. FUNDING This study was funded by Novo Nordisk A/S.
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Affiliation(s)
- Thomas R Pieber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | | | | | - Marlies Hart
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Soumitra Kar
- Novo Nordisk Service Centre India Private Ltd., Bangalore, India
| | - Ines Mursic
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Svehlikova
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martina Urschitz
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Agbozo E. Pancreatic insulinoma: Diagnosis and treatment of a rare tumour with misleading symptoms - A case report. Int J Surg Case Rep 2023; 109:108603. [PMID: 37536098 PMCID: PMC10412831 DOI: 10.1016/j.ijscr.2023.108603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Insulinomas are an uncommon occurrence, with an annual incidence of approximately 4 per million. These functional pancreatic neuroendocrine tumours can present with a myriad of nonspecific symptoms leading to frequent misdiagnoses. PRESENTATION OF CASE In this case report is presented a 55-year-old man who was misdiagnosed and managed for a seizure disorder with escalating antiepileptic treatments for 11 months. A thorough history after an attack was the main tool in solving the mystery of his refractory seizures, leading to the discovery of a pancreatic insulinoma. Biochemical tests revealed fasting hypoglycaemia and a relative hyperinsulinemia, and a distal pancreatic lesion measuring approximately 1.8 cm × 1.3 cm was detected on CT, MRI and endoscopic ultrasound. Successful laparoscopic pancreatic left resection led to complete resolution of symptoms and restoration of quality of life to pre-illness levels. DISCUSSION AND CONCLUSION Insulinomas have historically been difficult to diagnose because their symptoms mimic neurologic and psychiatric conditions. Patterns of symptom occurrence obtained from a carefully-taken history is the single most important tool in assessing patients with insulinomas, who usually present with unusual and refractory neuropsychiatric conditions.
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Desgrouas M, Demiselle J, Stiel L, Brunot V, Marnai R, Sarfati S, Fiancette M, Lambiotte F, Thille AW, Leloup M, Clerc S, Beuret P, Bourion AA, Daum J, Malhomme R, Ravan R, Sauneuf B, Rigaud JP, Dequin PF, Boulain T. Insulin therapy and blood glucose management in critically ill patients: a 1-day cross-sectional observational study in 69 French intensive care units. Ann Intensive Care 2023; 13:53. [PMID: 37330419 DOI: 10.1186/s13613-023-01142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Hyperglycaemia is common in critically ill patients, but blood glucose and insulin management may differ widely among intensive care units (ICUs). We aimed to describe insulin use practices and the resulting glycaemic control in French ICUs. We conducted a multicentre 1-day observational study on November 23, 2021, in 69 French ICUs. Adult patients hospitalized for an acute organ failure, severe infection or post-operative care were included. Data were recorded from midnight to 11:59 p.m. the day of the study by 4-h periods. RESULTS Two ICUs declared to have no insulin protocol. There was a wide disparity in blood glucose targets between ICUs with 35 different target ranges recorded. In 893 included patients we collected 4823 blood glucose values whose distribution varied significantly across ICUs (P < 0.0001). We observed 1135 hyperglycaemias (> 1.8 g/L) in 402 (45.0%) patients, 35 hypoglycaemias (≤ 0.7 g/L) in 26 (2.9%) patients, and one instance of severe hypoglycaemia (≤ 0.4 g/L). Four hundred eight (45.7%) patients received either IV insulin (255 [62.5%]), subcutaneous (SC) insulin (126 [30.9%]), or both (27 [6.6%]). Among patients under protocolized intravenous (IV) insulin, 767/1681 (45.6%) of glycaemias were above the target range. Among patients receiving insulin, short- and long-acting SC insulin use were associated with higher counts of hyperglycaemias as assessed by multivariable negative binomial regression adjusted for the propensity to receive SC insulin: incidence rate ratio of 3.45 (95% confidence interval [CI] 2.97-4.00) (P < 0.0001) and 3.58 (95% CI 2.84-4.52) (P < 0.0001), respectively. CONCLUSIONS Practices regarding blood glucose management varied widely among French ICUs. Administration of short or long-acting SC insulin was not unusual and associated with more frequent hyperglycaemia. The protocolized insulin algorithms used failed to prevent hyperglycaemic events.
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Affiliation(s)
- Maxime Desgrouas
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 45100, Orléans, France.
| | - Julien Demiselle
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- UMR 1260 Nanomedicine Regenerative, INSERM, Université de Strasbourg, Strasbourg, France
| | - Laure Stiel
- Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France
- UMR 1231, Inserm, LNC, Dijon, France
- LipSTIC, LabEx, Dijon, France
| | - Vincent Brunot
- Médecine Intensive Réanimation, Hôpital Universitaire Lapeyronie, Université de Montpellier, Montpellier, France
| | - Rémy Marnai
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Le Mans, 72000, Le Mans, France
| | - Sacha Sarfati
- Medical Intensive Care Unit, Normandie Univ, UNIROUEN, UR 3830, CHU Rouen, 76000, Rouen, France
| | - Maud Fiancette
- Service de Médecine Intensive Réanimation, CHD Vendée la Roche Sur Yon, La Roche Sur Yon, France
| | - Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Maxime Leloup
- Service de Réanimation, Groupe Hospitalier La Rochelle Ré Aunis, La Rochelle, France
| | - Sébastien Clerc
- Service de Médecine Intensive Et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Pascal Beuret
- Réanimation Et Soins Continus, Centre Hospitalier de Roanne, Roanne, France
| | | | - Johan Daum
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal Ballanger, Aulnay Sous Bois, France
| | - Rémi Malhomme
- Service de Réanimation, Centre Hospitalier Antibes Juan-Les-Pins, Antibes, France
| | - Ramin Ravan
- Réanimation Polyvalente et Surveillance Continue, Centre Hospitalier de Vichy, Vichy, France
| | - Bertrand Sauneuf
- Médecine Intensive Réanimation, Centre Hospitalier Public du Cotentin, 50100, Cherbourg en Cotentin, France
| | - Jean-Philippe Rigaud
- Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Avenue Pasteur, 76200, Dieppe, France
| | - Pierre-François Dequin
- Médecine Intensive - Réanimation, Hôpital Bretonneau, Tours, France
- Centre d'Étude Des Pathologies Respiratoires, UMR 1100, INSERM, Université de Tours, Tours, France
- INSERM CIC 1415, Tours, France
- CRICS-TriGGERSep Network, Paris, France
| | - Thierry Boulain
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 45100, Orléans, France
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Guo L, Wang J, Li L, Yuan L, Chen S, Wang H, Li T, Qi L, Yang H. A multicentre, prospective, non-interventional study evaluating the safety of dapagliflozin in patients with type 2 diabetes in routine clinical practice in China (DONATE). BMC Med 2023; 21:212. [PMID: 37316847 DOI: 10.1186/s12916-023-02906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There are few large-scale studies evaluating the safety of the sodium-glucose cotransporter-2 inhibitor, dapagliflozin, in Chinese patients with type 2 diabetes. DONATE, a multicentre, single-arm, prospective, non-interventional study, is the first real-world study evaluating the safety of dapagliflozin in Chinese patients with type 2 diabetes in routine clinical practice. METHODS Between August 2017 and July 2020, patients with type 2 diabetes who had initiated dapagliflozin therapy and received ≥1 dose were prospectively recruited from 88 hospitals in China. Patients were subsequently followed up for 24 weeks; if patients discontinued dapagliflozin they were followed up for an additional 7 days after treatment discontinuation. The primary outcome was the proportion of patients with adverse events and serious adverse events, particularly key adverse events of special interest (AESI) including urinary tract infection, genital tract infection (typical symptoms with or without microbiological diagnosis) and hypoglycaemia (typical symptoms with or without blood glucose ≤3.9 mmol/L, or blood glucose ≤3.9 mmol/L without symptoms). Exploratory outcomes included the absolute change in metabolic parameters and the proportion of patients with other AESI including volume depletion, abnormal blood electrolytes, polyuria, renal impairment, diabetic ketoacidosis, hepatic impairment and haematuria. RESULTS A total of 3000 patients were enrolled, of whom 2990 (99.7%) were included in the safety analysis set. Mean (SD) age was 52.6 (12.0) years, and 65.8% of patients were male. Mean (SD) duration of type 2 diabetes at enrolment was 8.4 (7.1) years. Mean (SD) treatment duration of dapagliflozin was 209.1 (157.6) days. Adverse events were reported in 35.4% (n = 1059) of patients during the 24-week follow-up period. Overall, 9.0% (n = 268) were related to treatment and 6.2% (n = 186) were serious. Urinary tract infection, genital tract infection and hypoglycaemia were reported in 2.3% (n = 70), 1.3% (n = 39) and 1.1% (n = 32) of patients, respectively. The proportion of patients with other AESI was also low: polyuria (0.7%; n = 21), volume depletion (0.3%; n = 9), renal impairment (0.3%; n = 8), hepatic impairment (0.2%; n = 7), haematuria (0.2%; n = 6) and diabetic ketoacidosis (0.1%; n = 2). CONCLUSIONS This study demonstrated that once-daily dapagliflozin was well tolerated in Chinese patients with type 2 diabetes and the overall safety profile of dapagliflozin in clinical practice in China was consistent with that reported in clinical trials. TRIAL REGISTRATION ClinicalTrials.gov, NCT03156985. Registered on 16 May, 2017.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dongdan Dahua Road, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Jing Wang
- Weifang Municipal Hospital, Weifang, People's Republic of China
| | - Li Li
- The First Affiliated Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Lin Yuan
- Zhuhai People's Hospital, Zhuhai, People's Republic of China
| | - Sheng Chen
- The People's Hospital of Liuyang, Liuyang, People's Republic of China
| | - Hui Wang
- Yancheng Tinghu District People's Hospital, Yancheng, People's Republic of China
| | - Tonghuan Li
- The 81st Hospital of People's Liberation Army, Nanjing, People's Republic of China
- Present Address: The Second Hospital of Nanjing, Nanjing, People's Republic of China
| | - Lin Qi
- Beijing Yanhua Hospital, Beijing, People's Republic of China
| | - Hong Yang
- Rui'an People's Hospital, Rui'an, People's Republic of China
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Singh J, Rasane P, Nanda V, Kaur S. Bioactive compounds of corn silk and their role in management of glycaemic response. J Food Sci Technol 2023; 60:1695-1710. [PMID: 37187994 PMCID: PMC10169954 DOI: 10.1007/s13197-022-05442-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 05/17/2023]
Abstract
Management of glycaemic response is perhaps the most critical part of antidiabetic therapy. Hypoglycaemia is an avoidable complication caused by conventional drugs used in the treatment of diabetes. It triggers commonly during the intensification of anti-hyperglycemic therapy used to render glycemic control in diabetic patients. The commercial oral hypoglycaemic drugs, insulin, herbal medicines and plant extracts are therefore used as a part of the treatment of diabetes. The demand for treating diabetes, through herbal and plant resources is due to their lesser adverse reactions and better phytochemical benefits. Corn silk has been shown to have anti-allergic, anti-inflammatory, and anti-hypertensive effects when extracted in various solvents. Corn silk has medicinal characteristics and has long been used as a traditional medicine in many nations, although the mechanism of action is unknown. The hypoglycaemic effects of corn silk are investigated in this review. The phytochemical components present in corn silk-like flavonoids, phenolics, terpenoids, tannins, sterols, and alkaloids are phytochemical components that have hypoglycemic activity and a mechanism for lowering blood glucose levels. There is a lack of a homogenized database on the hypoglycemic properties of corn silk thus the present review attempts to critically analyse it and provide specific recommendations of its doses.
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Affiliation(s)
- Jyoti Singh
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab 144411 India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab 144411 India
| | - Vikas Nanda
- Sant Longowal Institute of Engineering and Technology, Sangrur, Punjab 148106 India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab 144411 India
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Juneja D, Deepak D, Nasa P. What, why and how to monitor blood glucose in critically ill patients. World J Diabetes 2023; 14:528-538. [PMID: 37273246 PMCID: PMC10236998 DOI: 10.4239/wjd.v14.i5.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/17/2023] [Accepted: 03/07/2023] [Indexed: 05/15/2023] Open
Abstract
Critically ill patients are prone to high glycemic variations irrespective of their diabetes status. This mandates frequent blood glucose (BG) monitoring and regulation of insulin therapy. Even though the most commonly employed capillary BG monitoring is convenient and rapid, it is inaccurate and prone to high bias, overestimating BG levels in critically ill patients. The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach. Each of these has its own fallacies, while tight control increases risk of hypoglycemia, liberal BG targets make the patients prone to hyperglycemia. Moreover, the recent evidence suggests that BG indices, such as glycemic variability and time in target range, may also affect patient outcomes. In this review, we highlight the nuances associated with BG monitoring, including the various indices required to be monitored, BG targets and recent advances in BG monitoring in critically ill patients.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Desh Deepak
- Department of Critical Care, King's College Hospital, Dubai 340901, United Arab Emirates
| | - Prashant Nasa
- Department of Critical Care, NMC Speciality Hospital, Dubai 7832, United Arab Emirates
- Department of Critical Care, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
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Chan SP, Mumtaz M, Ratnasingam J, Tan ATB, Lim SC, Rosman A, Chee KH, Lim SK, Yew SS, Mohd Yusof BN, Lau BK, Kassim SB, Mohamed M. Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia. Malays Fam Physician 2023; 18:31. [PMID: 37292224 PMCID: PMC10246713 DOI: 10.51866/cpg.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naive or insulin-naive patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal-bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%-50% and taken during sahur, while the preRamadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp.
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Affiliation(s)
- Siew Pheng Chan
- MBBS (Mal) FRCP (Edin), AM (Mal), Consultant Endocrinologist, University of Malaya, Jln Profesor Diraja Ungku Aziz, Kuala Lumpur, Selangor, Malaysia.
| | - Malik Mumtaz
- MBBS (USM), MRCP (UK), FRCP (Edinburgh, Glasgow), Island Hospital Penang, 308, Jalan Macalister, George Town, Pulau, Pinang, Malaysia
| | - Jeyakantha Ratnasingam
- MMed (UM), Fellowship in Endocrinology (Australia), MD (UKM), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Alexander Tong Boon Tan
- MB ChB (Liverpool), MRCP (UK), FRCP (Edinburgh), Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, Selangor, Malaysia
| | - Siang Chin Lim
- DM (UKM), MRCP (UK), Fellowship in Endocrinology (Malaysia), Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia
| | - Azhari Rosman
- MD (UM, Mal), MRCP (UK), FNHAM (MAl), FAPSIC (Asia Pacific), FAsCC (ASEAN), FESC (EU), FACC (US), Institut Jantung Negara,145, Jln Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kok Han Chee
- NHAM, MMed (Mal), MBBS (UM), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- AM (MAL), FRCP(Edin), MBBS(MAL), MRCP(UK), University of Malaya, Jln Profesor, Diraja Ungku Aziz, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Shiong Shiong Yew
- MBBS (UM), MRCP (UK), Mahkota Medical Centre, No 3, Mahkota Melaka, Jln Merdeka, Melaka, Malaysia
| | - Barakatun-Nisak Mohd Yusof
- BS (Diabetics; UKM), Ph.D (UKM), Universiti Putra Malaysia, Jalan, Universiti 1 Serdang, Seri Kembangan, Selangor, Malaysia
| | - Bik Kui Lau
- MD (USM), MRCP (UK), KPJ Kuching Specialist Hospital, Lot 18807, Block 11 Muara Tebas, Land District, Jln Stutong, Kuching, Sarawak, Malaysia
| | - Saiful Bahari Kassim
- MB BCh BAO (NUIG), PGCMedEd (QUB), MRCP (U.K.), FRCP (Lon), FRCP (Glasg) FRCPI (Ire) FRCP (Edin), CCST (JRCPTB U.K. Endocrinology & Diabetes; Internal Medicine), Gleneagles Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Mafauzy Mohamed
- MBBS (Adelaide), MRCP (UK), MMedSci (University of Sheffield), FRCP (Edinburgh), Universiti Sains Malaysia Hospital, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
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Cheah KL, Yaacob LH, Abdul Rahman R. Dumping syndrome after bariatric surgery in a pregnant woman: A case report. Malays Fam Physician 2023; 18:24. [PMID: 37292225 PMCID: PMC10246712 DOI: 10.51866/cr.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dumping syndrome after bariatric surgery is common. However, it is rarely seen during pregnancy because patients are usually advised to avoid pregnancy immediately after surgery. This case highlights the importance of avoidance of pregnancy after bariatric surgery. We report a case of unplanned pregnancy in a 35-year-old woman with a history of subfertility for 8 years who conceived spontaneously 3 months after gastric bypass surgery. This occurred because there was no contraception offered to her after the procedure. The pregnancy was complicated with recurrent episodes of hypoglycaemia secondary to dumping syndrome. Primary care providers need to be vigilant and have a high index of suspicion for dumping syndrome in pregnant obese women who have undergone bariatric surgery.
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Affiliation(s)
- Kae Ling Cheah
- MD (UMS), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Lili Husniati Yaacob
- MBBS (Adelaide), MMed (Family Med)(USM), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia.
| | - Razlina Abdul Rahman
- MBBS (Adelaide), MMed (Family Med)(USM), Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
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Crutzen S, Baas G, Denig P, Heringa M, Taxis K. Pharmacist-led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among people with type 2 diabetes. Res Social Adm Pharm 2023; 19:783-792. [PMID: 36740525 DOI: 10.1016/j.sapharm.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Potential overtreatment with cardiometabolic medication (i.e., glucose lowering medication, antihypertensives and statins) has been observed in 10-40% of older people with type 2 diabetes (T2D). OBJECTIVE The potential effects of a pharmacist-led clinical medication review targeted at T2D patients who were at high risk of hypoglycaemia will be investigated. METHODS A quasi-experimental study was conducted in 14 Dutch community pharmacies. Patients with a high risk of hypoglycaemia were identified using a previously developed algorithm. Pharmacists confirmed eligibility and selected patients for the intervention. Remaining eligible patients were included as controls receiving usual care. The primary outcome was the proportion of intervention patients for whom an action on deprescribing or appropriate use of cardiometabolic medication was implemented. After three months, changes in cardiometabolic medication were compared between the intervention and control group using a Fischer exact test. RESULTS In total 90 intervention patients and 107 control patients were included. Intervention patients had an average age of 70, used on average 10 medications, five of which were cardiometabolic medication. For half of the intervention patients an action on deprescribing cardiometabolic medication was implemented (n = 25) and/or an advice about appropriate use of cardiometabolic medication was given (n = 22). In 48% of intervention patients at least one cardiometabolic medication (e.g. insulin, sulfonylurea, diuretic, beta-blocker, statin) was either stopped or reduced in dose compared to 31% of control patients (p = 0.018). CONCLUSIONS A pharmacist-led tailored clinical medication review has the potential to increase deprescribing and improve appropriate use of cardiometabolic medication in half of T2D patients at high risk of hypoglycaemia.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, the Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, the Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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Scheen A, Paquot N, Lefèbvre P. [Reactive hypoglycaemia, a frequently mentioned functional disorder, yet overestimated in clinical practice]. Rev Med Liege 2023; 78:363-368. [PMID: 37350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Malaises are often attributed to hypoglycaemia in nondiabetic people who don't have any other serious medical problem. Reactive hypoglycaemia, the most frequent one, may be considered as a functional disorder. However, its diagnosis is often overused, because not really demonstrated in most instances. The diagnosis of hypoglycaemia should be structured, based upon the Whipple triad. First, the medical interrogatory must search for adrenergic and neuroglucopenic symptoms that suggest hypoglycaemia. Second, if the malaise is due to a hypoglycaemia, it should resume rapidly after the administration of sugar. Third, hypoglycaemia must be confirmed by a measurement of a low glucose level at the time of a malaise. The latter approach is facilitated by the use of home blood monitoring, a strategy that is now preferred to the use of an oral glucose tolerance test, a non-physiological test far from real-life conditions. When the diagnosis is made based upon this triad, the medical interview should precise the severity of the symptoms and focus on the chronology of the malaises, typically 2-3 hours after a sugar-enriched meal in case of a reactive hypoglycaemia. Therapeutic approach of this functional disorder mostly relies on dietary advices.
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Affiliation(s)
- André Scheen
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique
| | - Nicolas Paquot
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique
| | - Pierre Lefèbvre
- Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique
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Ruan Y, Mercuri L, Papadimitriou D, Galdikas A, Roadknight G, Davies J, Glampson B, Mayer E, Hill NE, Rea R. Increase in hypoglycaemia and hyperglycaemia in people with diabetes admitted to hospital during COVID-19 pandemic. J Diabetes Complications 2023; 37:108474. [PMID: 37207507 DOI: 10.1016/j.jdiacomp.2023.108474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/31/2023] [Accepted: 04/08/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND We used detailed information on patients with diabetes admitted to hospital to determine differences in clinical outcomes before and during the COVID-19 pandemic in the UK. METHODS The study used electronic patient record data from Imperial College Healthcare NHS Trust. Hospital admission data for patients coded for diabetes was analysed over three time periods: pre-pandemic (31st January 2019-31st January 2020), Wave 1 (1st February 2020-30th June 2020), and Wave 2 (1st September 2020-30th April 2021). We compared clinical outcomes including glycaemia and length of stay. RESULTS We analysed data obtained from 12,878, 4008 and 7189 hospital admissions during the three pre-specified time periods. The incidence of Level 1 and Level 2 hypoglycaemia was significantly higher during Waves 1 and 2 compared to the pre-pandemic period (25 % and 25.1 % vs. 22.9 % for Level 1 and 11.7 % and 11.5 % vs. 10.3 % for Level 2). The incidence of hyperglycaemia was also significantly higher during the two waves. The median hospital length of stay increased significantly (4.1[1.6, 9.8] and 4.0[1.4, 9.4] vs. 3.5[1.2, 9.2] days). CONCLUSIONS During the COVID-19 pandemic in the UK, hospital in-patients with diabetes had a greater number of hypoglycaemic/hyperglycaemic episodes and an increased length of stay when compared to the pre-pandemic period. This highlights the necessity for a focus on improved diabetes care during further significant disruptions to healthcare systems and ensuring minimisation of the impact on in-patient diabetes services. SUMMARY Diabetes is associated with poorer outcomes from COVID-19. However the glycaemic control of inpatients before and during the COVID-19 pandemic is unknown. We found the incidence of hypoglycaemia and hyperglycaemia was significantly higher during the pandemic highlighting the necessity for a focus on improved diabetes care during further pandemics.
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Affiliation(s)
- Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
| | - Luca Mercuri
- Imperial Clinical Analytics, Research & Evaluation Centre, Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Dimitri Papadimitriou
- Imperial Clinical Analytics, Research & Evaluation Centre, Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Algirdas Galdikas
- Imperial Clinical Analytics, Research & Evaluation Centre, Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | | | - Jim Davies
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Ben Glampson
- Imperial Clinical Analytics, Research & Evaluation Centre, Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Erik Mayer
- Imperial Clinical Analytics, Research & Evaluation Centre, Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Neil E Hill
- Endocrinology & Diabetes, Imperial College Healthcare NHS Trust, London, UK.
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
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Laugesen C, Ranjan AG, Schmidt S, Nørgaard K. Pen-administered low-dose dasiglucagon vs usual care for prevention and treatment of non-severe hypoglycaemia in people with type 1 diabetes during free-living conditions: a Phase II, randomised, open-label, two-period crossover trial. Diabetologia 2023:10.1007/s00125-023-05909-4. [PMID: 37037948 DOI: 10.1007/s00125-023-05909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/31/2023] [Indexed: 04/12/2023]
Abstract
AIMS/HYPOTHESIS Consumption of excess carbohydrates to manage hypoglycaemia can lead to rebound hyperglycaemia and promote weight gain. The objective of this trial was to evaluate the efficacy, safety and feasibility of pen-administered low-dose dasiglucagon for prevention and treatment of non-severe hypoglycaemia in people with type 1 diabetes during free-living conditions. METHODS Twenty-four adults with insulin pump-treated type 1 diabetes (HbA1c ≤70 mmol/mol [8.5%]) completed a randomised, open-label, two-period crossover study with 2 week periods. During the usual care and dasiglucagon intervention (DASI) periods, participants managed impending and manifested episodes of hypoglycaemia with regular carbohydrate consumption or pen-administered low-dose (80 μg) s.c. dasiglucagon, respectively. Glycaemic control was evaluated using continuous glucose monitoring (Dexcom G6) and event registration of prevention and treatment episodes. RESULTS Compared with usual care, the mean difference (95% CI) in the DASI period for time in (3.9-10.0 mmol/l) and below (<3.9 mmol/l) range was 2.4 %-points (-0.7, 5.5) and -0.5 %-points (-1.2, 0.2), respectively. In the DASI period, recovery rate (time from hypoglycaemia treatment to euglycaemia) was 44% (11, 87) faster while total daily carbohydrate intake was reduced by 11% (-18, -3). Dasiglucagon use was safe and well tolerated with mild nausea being the most frequent adverse effect. Among the participants, 96% (p<0.0001) were likely to include dasiglucagon in their future routine management of hypoglycaemia. CONCLUSIONS/INTERPRETATION Use of low-dose dasiglucagon to prevent and treat non-severe hypoglycaemia during free-living conditions was safe, fast and efficacious while significantly reducing the total daily carbohydrate intake and yielding high treatment satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT04764968 FUNDING: The study was an investigator-initiated trial. Zealand Pharma supplied the investigational drug and device and provided financial support for the conduct of the trial.
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Affiliation(s)
| | - Ajenthen G Ranjan
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Signe Schmidt
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kirsten Nørgaard
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Blaise Pascal FN, Chikumbanje SS, Mbweza R, Kumitawa A, Kapalamula T, Thomson E, Borgstein E, Pollach G, Namboya F. Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational study. BMC Anesthesiol 2023; 23:117. [PMID: 37038110 PMCID: PMC10084617 DOI: 10.1186/s12871-023-02073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi. METHODOLOGY This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%. RESULTS Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means. CONCLUSION Glycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.
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Affiliation(s)
- Furaha Nzanzu Blaise Pascal
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.
- Faculty of Medicine, Université Catholique du Graben de Butembo, Butembo, Democratic Republic of Congo.
| | - Singatiya Stella Chikumbanje
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Anaesthesia, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Anaesthesia and Intensive Care, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Rachel Mbweza
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Anaesthesia, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Andrew Kumitawa
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tiyamike Kapalamula
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Emma Thomson
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric Borgstein
- Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Gregor Pollach
- Department of Anaesthesia and Intensive Care, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felix Namboya
- Department of Anaesthesia, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Anaesthesia and Intensive Care, Kamuzu University of Health Sciences, Blantyre, Malawi
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McNeilly AD, Gallagher JR, Evans ML, de Galan BE, Pedersen-Bjergaard U, Thorens B, Dinkova-Kostova AT, Huang JT, Ashford MLJ, McCrimmon RJ. Chronic hyperglycaemia increases the vulnerability of the hippocampus to oxidative damage induced during post-hypoglycaemic hyperglycaemia in a mouse model of chemically induced type 1 diabetes. Diabetologia 2023:10.1007/s00125-023-05907-6. [PMID: 37015997 DOI: 10.1007/s00125-023-05907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/26/2023] [Indexed: 04/06/2023]
Abstract
AIMS/HYPOTHESIS Chronic hyperglycaemia and recurrent hypoglycaemia are independently associated with accelerated cognitive decline in type 1 diabetes. Recurrent hypoglycaemia in rodent models of chemically induced (streptozotocin [STZ]) diabetes leads to cognitive impairment in memory-related tasks associated with hippocampal oxidative damage. This study examined the hypothesis that post-hypoglycaemic hyperglycaemia in STZ-diabetes exacerbates hippocampal oxidative stress and explored potential contributory mechanisms. METHODS The hyperinsulinaemic glucose clamp technique was used to induce equivalent hypoglycaemia and to control post-hypoglycaemic glucose levels in mice with and without STZ-diabetes and Nrf2-/- mice (lacking Nrf2 [also known as Nfe2l2]). Subsequently, quantitative proteomics based on stable isotope labelling by amino acids in cell culture and biochemical approaches were used to assess oxidative damage and explore contributory pathways. RESULTS Evidence of hippocampal oxidative damage was most marked in mice with STZ-diabetes exposed to post-hypoglycaemic hyperglycaemia; these mice also showed induction of Nrf2 and the Nrf2 transcriptional targets Sod2 and Hmox-1. In this group, hypoglycaemia induced a significant upregulation of proteins involved in alternative fuel provision, reductive biosynthesis and degradation of damaged proteins, and a significant downregulation of proteins mediating the stress response. Key differences emerged between mice with and without STZ-diabetes following recovery from hypoglycaemia in proteins mediating the stress response and reductive biosynthesis. CONCLUSIONS/INTERPRETATION There is a disruption of the cellular response to a hypoglycaemic challenge in mice with STZ-induced diabetes that is not seen in wild-type non-diabetic animals. The chronic hyperglycaemia of diabetes and post-hypoglycaemic hyperglycaemia act synergistically to induce oxidative stress and damage in the hippocampus, possibly leading to irreversible damage/modification to proteins or synapses between cells. In conclusion, recurrent hypoglycaemia in sub-optimally controlled diabetes may contribute, at least in part, to accelerated cognitive decline through amplifying oxidative damage in key brain regions, such as the hippocampus. DATA AVAILABILITY The datasets generated during and/or analysed during the current study are available in ProteomeXchange, accession no. 1-20220824-173727 ( www.proteomexchange.org ). Additional datasets generated during and/or analysed during the present study are available from the corresponding author upon reasonable request.
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Affiliation(s)
- Alison D McNeilly
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Jennifer R Gallagher
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Mark L Evans
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Bastiaan E de Galan
- 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
| | | | - Bernard Thorens
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Albena T Dinkova-Kostova
- Division of Cancer Research, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Jeffrey-T Huang
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
- Biomarker and Drug Analysis Core Facility, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Michael L J Ashford
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK.
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Sepúlveda E, Jacob P, Poínhos R, Carvalho D, Vicente SG, Smith EL, Shaw JAM, Speight J, Choudhary P, de Zoysa N, Amiel SA. Changes in attitudes to awareness of hypoglycaemia during a hypoglycaemia awareness restoration programme are associated with avoidance of further severe hypoglycaemia episodes within 24 months: the A2A in HypoCOMPaSS study. Diabetologia 2023; 66:631-641. [PMID: 36538062 PMCID: PMC9947080 DOI: 10.1007/s00125-022-05847-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/06/2022] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months). METHODS This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring. RESULTS The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months; this decreased to <20% at 24 weeks and after 24 months (p=0.001). The attitudinal barrier 'hyperglycaemia avoidance prioritised' (η2p=0.250, p=0.001) decreased from baseline to 24 weeks, and this decrease was maintained at 24 months (mean±SD=5.3±0.3 vs 4.3±0.3 vs 4.0±0.3). The decrease in 'asymptomatic hypoglycaemia normalised' from baseline (η2p=0.113, p=0.045) was significant at 24 weeks (1.5±0.3 vs 0.8±0.2). Predictors of incomplete hypoglycaemia response (one or more further episodes of severe hypoglycaemia) were higher baseline rates of severe hypoglycaemia, higher baseline scores for 'asymptomatic hypoglycaemia normalised', reduced change in 'asymptomatic hypoglycaemia normalised' scores at 24 weeks, and lower baseline 'hypoglycaemia concern minimised' scores (all p<0.05). CONCLUSIONS/INTERPRETATION Participation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with 'hyperglycaemia avoidance prioritised' most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition 'asymptomatic hypoglycaemia normalised'. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in individuals prone to severe hypoglycaemia episodes. CLINICAL TRIALS REGISTRATION www.isrctn.org : ISRCTN52164803 and https://eudract.ema.europa.eu : EudraCT2009-015396-27.
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Affiliation(s)
- Eduardo Sepúlveda
- Diabetes Research Group, King's College London, London, UK
- Centre for Psychology at Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Peter Jacob
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Selene G Vicente
- Centre for Psychology at Universidade do Porto, Faculty of Psychology and Educational Sciences, Universidade do Porto, Porto, Portugal
| | - Emma L Smith
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Pratik Choudhary
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Nicole de Zoysa
- Diabetes Research Group, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Stephanie A Amiel
- Diabetes Research Group, King's College London, London, UK.
- King's College Hospital NHS Foundation Trust, London, UK.
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Moreno-Fernandez J, Sastre J, Pinés P, Calderon-Vicente D, Gargallo J, Muñoz-Rodriguez JR. To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes: Results of a multicentre study. ENDOCRINOL DIAB NUTR 2023; 70:270-276. [PMID: 37116972 DOI: 10.1016/j.endien.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/08/2022] [Indexed: 04/30/2023]
Abstract
AIM To evaluate the use and clinical effect of intermittently scanned continuous glucose monitoring (isCGM) in adults with type 1 diabetes (T1D) in a public health service scenario. METHOD Cross-sectional retrospective analysis of all patients with T1D and medical indication for isCGM use from a cohort followed since 2010 at Castilla-La Mancha Public Health Service (Spain). Primary outcome was HbA1c change during the first year of follow-up after isCGM initiation. Secondary outcomes included evaluation of self-monitoring of blood glucose (SMBG), isCGM and insulin use, along with glycometric indexes. RESULTS A total of 945 T1D patients were analyzed. Median age was 49.5 years (IQ range 19.0 years) and T1D duration of 28.9 years (IQ range 14.0 years). The most frequent insulin therapy alternatives were multiple daily injections (85%) followed by insulin pump (11%). Eighty percent of the patients were active isCGM users with a 90% of adherence to the device. Patients showed a mean daily scan frequency of 10.1±6.4scans/day. Daily SMBG reduced by -3.5 test/day [95% CI -3.7, -3.2; P<0.001]. We detected an HbA1c reduction of -0.3% (-4mmol/mol) [95% CI -0.2, -0.4 (-3, -5); P<0.001] at the end of the follow-up. An inverse correlation between HbA1c levels at the end of the follow-up and daily frequency of isCGM scanning (R=-0.34, P<0.001) was observed. Dropout rate was 4%, and 4% of patients were not willing to use isCGM. CONCLUSIONS Adult patients with T1D improved glycaemic control after isCGM initiation in a public health service scenario. Despite described clinical benefits, a higher than expected percentage of patients were not using isCGM technology. NCT05095610.
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Affiliation(s)
- Jesus Moreno-Fernandez
- Service of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain.
| | - Julia Sastre
- Service of Endocrinology and Nutrition, Toledo University Hospital, Toledo, Spain
| | - Pedro Pinés
- Service of Endocrinology and Nutrition, Albacete University Hospital, Albacete, Spain
| | | | - Javier Gargallo
- Service of Endocrinology and Nutrition, Santa Barbara Hospital, Puertollano, Ciudad Real, Spain
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Drenthen LCA, Ajie M, Abbink EJ, Rodwell L, Thijssen DHJ, Tack CJ, de Galan BE. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study. Diabetologia 2023; 66:1035-1044. [PMID: 36879098 PMCID: PMC9988601 DOI: 10.1007/s00125-023-05893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
AIMS/HYPOTHESIS It is generally recommended to reduce basal insulin doses after exercise to reduce the risk of post-exercise nocturnal hypoglycaemia. Based on its long t½, it is unknown whether such adjustments are required or beneficial for insulin degludec. METHODS The ADREM study (Adjustment of insulin Degludec to Reduce post-Exercise (nocturnal) hypoglycaeMia in people with diabetes) was a randomised controlled, crossover study in which we compared 40% dose reduction (D40), or postponement and 20% dose reduction (D20-P), with no dose adjustment (CON) in adults with type 1 diabetes at elevated risk of hypoglycaemia, who performed a 45 min aerobic exercise test in the afternoon. All participants wore blinded continuous glucose monitors for 6 days, measuring the incidence of (nocturnal) hypoglycaemia and subsequent glucose profiles. RESULTS We recruited 18 participants (six women, age 38 ± 13 years, HbA1c 56 ± 8 mmol/mol [7.3 ± 0.8%], mean ± SD). Time below range (i.e. glucose <3.9 mmol/l) the night after the exercise test was generally low and occurrence did not differ between the treatment regimens. During the subsequent whole day, time below range was lower for D40 compared with CON (median [IQR], 0 [0-23] vs 18 [0-55] min, p=0.043), without differences in the number of hypoglycaemic events. Time above range (i.e. glucose >10 mmol/l) was greater for D20-P vs CON (mean ± SEM, 584 ± 81 vs 364 ± 66 min, p=0.001) and D40 (385 ± 72 min, p=0.003). CONCLUSIONS/INTERPRETATION Post-exercise adjustment of degludec does not mitigate the risk of subsequent nocturnal hypoglycaemia in people with type 1 diabetes. Although reducing degludec reduced next-day time below range, this did not translate into fewer hypoglycaemic events, while postponing degludec should be avoided because of increased time above range. Altogether, these data do not support degludec dose adjustment after a single exercise bout. TRIAL REGISTRATION EudraCT number 2019-004222-22 FUNDING: The study was funded by an unrestricted grant from Novo Nordisk, Denmark.
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Affiliation(s)
- Linda C A Drenthen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mandala Ajie
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Martínez-Perez P, Orozco-Beltrán D, Pomares-Gómez F, Gil-Guillén VF, Quesada JA, López-Pineda A, Nouni-García R, Carratalá-Munuera C. [Factors associated with dissatisfaction with pharmacological treatment in patients with type 2 diabetes mellitus: A cross-sectional study]. J Healthc Qual Res 2023; 38:120-127. [PMID: 35933321 DOI: 10.1016/j.jhqr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/31/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Diabetes is a chronic disease with a high impact on both health and Quality of Life Related to Health (QLRH). To evaluate the satisfaction of treatment in patients with type 2 diabetes mellitus through the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and its relationship with sociodemographic variables, with antidiabetic medication and clinical-analytical variables. MATERIALS AND METHODS This cross-sectional study was conducted in General University Hospital of San Juan de Alicante between September 2016 and December 2017. Two hundred thirty-two patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, treated with antidiabetic medication were included. The Spanish version of the DTSQ scale was used to measure satisfaction with treatment. Factors associated with low satisfaction were analyzed by applying the Chi-square test for qualitative variables and Student-T for quantitative variables. To estimate magnitudes of association, logistic models were adjusted. RESULTS Two hundred thirty-two patients were included in this study. 21.5% of the patients presented low satisfaction with the treatment. Patients who presented low satisfaction with treatment were associated with medications that could cause hypoglycemia (OR: 2.872 [1.195-6.903]), HbA1c levels higher than 7% (OR: 2.260 [1.005-5.083]) and drugs administered by the route oral (OR: 2.749 [1.233-6.131]). CONCLUSIONS Patients with type 2 diabetes mellitus who had a lower score on the DTSQ questionnaire were associated with medications that produced hypoglycaemia, and with higher levels of HbA1c higher than 7%, and those who took oral medication.
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Affiliation(s)
- P Martínez-Perez
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - D Orozco-Beltrán
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - F Pomares-Gómez
- Servicio de Endocrinología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, España
| | - V F Gil-Guillén
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
| | - J A Quesada
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España.
| | - A López-Pineda
- Fisabio, Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, Valencia, España
| | - R Nouni-García
- Fisabio, Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, Valencia, España
| | - C Carratalá-Munuera
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, España
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Wang J, Gong TL, Pan CD. Hemiplegia due to hypoglycaemia followed by haemicorea after correction of glycaemic values. Neurol Sci 2023; 44:1125-6. [PMID: 36370205 DOI: 10.1007/s10072-022-06461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/16/2022] [Indexed: 11/13/2022]
Abstract
A 69-year-old man suffered from hemiplegia of the left limb due to hypoglycaemia. After 3 h of oral supplementation with sugar water, the patient recovered from hemiplegia but then presented symptoms of haemichorea. To our knowledge, a case of abnormal glucose metabolism complicated with two types of motor disturbance has not been reported previously.
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He A, Guo Y, Xu Z, Yan J, Xie L, Li Y, Lv D, Luo M. Hypoglycaemia aggravates impaired endothelial-dependent vasodilation in diabetes by suppressing endothelial nitric oxide synthase activity and stimulating inducible nitric oxide synthase expression. Microvasc Res 2023; 146:104468. [PMID: 36513147 DOI: 10.1016/j.mvr.2022.104468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes exacerbates vascular injury by triggering endothelial dysfunction. Endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) both play major roles in endothelial dysfunction. However, effects of hypoglycaemia, the main complication of the insulin therapy to the glycemic control in diabetes, on eNOS activity and iNOS expression, and underlying mechanisms in diabetes remain unknown. Hence, we aimed to determine the effects of hypoglycaemia on eNOS activity and iNOS expression in different arterial beds of diabetic rats. METHODS Sprague-Dawley rats were subjected to Streptozotocin (STZ) combined with high fat diet (HFD) to induce diabetes and then received insulin injection to attain acute and recurrent hypoglycaemia. Immunoblotting was used to analyse the phosphorylation and O-glycosylation status of eNOS and iNOS level from thoracic aorta and mesenteric artery tissue. Indicators of oxidative stress from plasm were determined, and endothelial-dependent vasodilation was detected via wire myograph system. RESULTS Hypoglycaemia was associated with a marked increase in eNOS O-GlcNAcylation and decrease in Serine (Ser)-1177 phosphorylation from thoracic aortas and mesenteric arteries. Moreover, hypoglycaemia resulted in elevated phosphorylation of eNOS at Threonine (Thr)-495 site in mesenteric arteries. Besides, changes in these post-translational modifications were associated with increased O-GlcNAc transferase (OGT), decreased phosphorylation of Akt at Ser-473, and increased protein kinase C α subunit (PKCα). iNOS expression was induced in hypoglycaemia. Furthermore, endothelial-dependent vasodilation was impaired under insulin-induced hypoglycaemia, and further in recurrent hypoglycaemia. CONCLUSIONS Conclusively, these findings strongly indicate that hypoglycaemia-dependent vascular dysfunction in diabetes is mediated through altered eNOS activity and iNOS expression. Therefore, this implies that therapeutic modulation of eNOS activity and iNOS expression in diabetics under intensive glucose control may prevent and treat adverse cardiovascular events.
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Tan CSS, Wong YJ, Tang KF, Lee SWH. Diabetes, Ramadan, and driving - Ensuring patient safety while respecting religious autonomy: A qualitative study. Diabetes Metab Syndr 2023; 17:102724. [PMID: 36791634 DOI: 10.1016/j.dsx.2023.102724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIMS Hypoglycaemia due to fasting during Ramadan may affect the ability to perform complex activities among people with type 2 diabetes mellitus (T2D), but it is unclear how this affects one's ability to drive. This study aims to explore driving experiences and coping strategies to ensure safe driving among people with T2D who fast during Ramadan. METHODS We conducted an exploratory qualitative study and purposefully selected people with T2D who drove and fasted during the past Ramadan period in 2019. In-depth face-to-face interviews were conducted and transcribed verbatim. Data were analysed thematically using a constant comparative method until saturation was achieved (n = 16). RESULTS Two major themes were identified, namely: (1) knowing oneself and (2) voluntary self-restriction. Participants described the importance of understanding how Ramadan fasting affected them and their level of alertness. As such, participants often adjusted their daily activities and tested their blood glucose levels to prevent experiencing hypoglycaemia. Other coping strategies reported include adjusting their medications and driving restrictions or driving in the mornings when they were more alert. Findings from this study shed light on participants' experiences and coping mechanisms while driving during Ramadan. CONCLUSION Given the risks and effects of hypoglycaemia among those who fast, there is a need to provide appropriate and focused patient education during Ramadan to people with T2D to ensure they can perform complex activities such as driving safely, especially in Muslim majority countries.
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Affiliation(s)
| | - Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.
| | - Kar Foong Tang
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia; School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
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Hvid H, Brand CL, Hummelshøj T, Jensen S, Bouman SD, Bowler A, Poulsen BR, Tiainen P, Åkertröm T, Demozay D, Hoeg-Jensen T, Ingvorsen C, Pedersen TÅ, McGuire J, Egebjerg T, Cappelen KA, Eliasen IP, Hansen BF, Hennen S, Stidsen CE, Olsen GS, Roed NK. Preclinical exploration of combined glucagon inhibition and liver-preferential insulin for treatment of diabetes using in vitro assays and rat and mouse models. Diabetologia 2023; 66:376-389. [PMID: 36404376 PMCID: PMC9807490 DOI: 10.1007/s00125-022-05828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022]
Abstract
AIMS/HYPOTHESIS Normalisation of blood glucose in individuals with diabetes is recommended to reduce development of diabetic complications. However, risk of severe hypoglycaemia with intensive insulin therapy is a major obstacle that prevents many individuals with diabetes from obtaining the recommended reduction in HbA1c. Inhibition of glucagon receptor signalling and liver-preferential insulin action have been shown individually to have beneficial effects in preclinical models and individuals with diabetes (i.e. improved glycaemic control), but also have effects that are potential safety risks (i.e. alpha cell hyperplasia in response to glucagon receptor antagonists and increased levels of liver triacylglycerols and plasma alanine aminotransferase activity in response to glucagon receptor antagonists and liver-preferential insulin). We hypothesised that a combination of glucagon inhibition and liver-preferential insulin action in a dual-acting molecule would widen the therapeutic window. By correcting two pathogenic mechanisms (dysregulated glucagon signalling and non-physiological distribution of conventional insulin administered s.c.), we hypothesised that lower doses of each component would be required to obtain sufficient reduction of hyperglycaemia, and that the undesirable effects that have previously been observed for monotreatment with glucagon antagonists and liver-preferential insulin could be avoided. METHODS A dual-acting glucagon receptor inhibitor and liver-preferential insulin molecule was designed and tested in rodent models (normal rats, rats with streptozotocin-induced hyperglycaemia, db/db mice and mice with diet-induced obesity and streptozotocin-induced hyperglycaemia), allowing detailed characterisation of the pharmacokinetic and pharmacodynamic properties of the dual-acting molecule and relevant control compounds, as well as exploration of how the dual-acting molecule influenced glucagon-induced recovery and spontaneous recovery from acute hypoglycaemia. RESULTS This molecule normalised blood glucose in diabetic models, and was markedly less prone to induce hypoglycaemia than conventional insulin treatment (approximately 4.6-fold less potent under hypoglycaemic conditions than under normoglycaemic conditions). However, compared to treatment with conventional long-acting insulin, this dual-acting molecule also increased triacylglycerol levels in the liver (approximately 60%), plasma alanine aminotransferase levels (approximately twofold) and alpha cell mass (approximately twofold). CONCLUSIONS/INTERPRETATION While the dual-acting glucagon receptor inhibitor and liver-preferential insulin molecule showed markedly improved regulation of blood glucose, effects that are potential safety concerns persisted in the pharmacologically relevant dose range.
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Affiliation(s)
- Henning Hvid
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | | | - Tina Hummelshøj
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | - Sanne Jensen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | | | - Andrew Bowler
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
- QC Laboratories, Syntese A/S, Hvidovre, Denmark
| | | | - Peter Tiainen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | | | - Damien Demozay
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | | | | | | | - Jim McGuire
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
- Catalyst Biosciences, San Francisco, CA, USA
| | - Thomas Egebjerg
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | | | - Ina P Eliasen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | - Bo F Hansen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | - Stephanie Hennen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
- Grünethal GmbH, Aachen, Germany
| | | | - Grith S Olsen
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark
| | - Nikolaj K Roed
- Research & Early Development, Novo Nordisk A/S, Måløv, Denmark.
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Habibu B, Aluwong T, Makun HJ, Yaqub LS, Kawu MU. Role of maternal variables on the development of neonatal hypoglycaemia and influence of neonatal hypoglycaemia on performance of goat kids. Vet Anim Sci 2023; 19:100287. [PMID: 36712821 DOI: 10.1016/j.vas.2023.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The study evaluated the influence of maternal variables (age, body weight and body mass index; BMI) during mating on the development of hypoglycaemia and investigated whether hypoglycaemia at birth impairs thermoregulation, metabolism, body weight gain and immunoglobulin concentration in neonatal goat kids. Post-kidding, the kids born with hypoglycaemia (n = 19) and normoglycaemia (n = 19) were immediately identified and postnatal blood samples, body weight and cardinal physiological variables were determined. Results revealed no significant (P < 0.05) difference in pre-mating maternal variables between dams that kidded hypoglycaemic and normoglycaemic kids. Kids born with hypoglycaemia had lower (P <0.05) blood glucose concentration from birth, until Day 2, when values became comparable between the two groups. Afternoon respiratory and pulse rates were markedly (P < 0.05) unstable in kids born with hypoglycaemia and the early postnatal rise (P < 0.05) in morning rectal temperature in both groups was accompanied by a decrease (P < 0.05) on day 20 in kids born with hypoglycaemia. Blood cholesterol and triglyceride concentrations were lower (P < 0.05) in hypoglycaemic kids and the normoglycaemic kids showed marked increase (P < 0.05) in circulating immunoglobulin concentration 24 h after birth, while age had no (P > 0.05) effect in hypoglycaemic kids. A more pronounced decrease (P < 0.05) in weekly weight gain was observed in hypoglycaemic kids. It was concluded that neonatal goat kids born with hypoglycaemia may have compromised thermoregulation, metabolism and body weight gain, and the cause of hypoglycaemia in kids may not be related to pre-mating maternal variables.
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Heath M, Torpy DJ, Rushworth RL. An analysis of the utilisation of medical identification jewellery among children and young adults with type 1 diabetes mellitus in Australia. Endocrine 2023; 79:72-79. [PMID: 36334194 PMCID: PMC9813105 DOI: 10.1007/s12020-022-03224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
AIMS People with type 1 diabetes mellitus (T1DM) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among people with T1DM aged 0-24 years in Australia. METHODS A cross sectional analysis of subscription data to the largest medical identification jewellery service in Australia was analysed by age, sex and geographic location using Australian population data from 2018. RESULTS There were 1599 people with T1DM aged 0-24 in the database, but only 1061 had an active subscription, corresponding to an active subscription rate of 13.28/100,000 population or ~5% of the estimated patient population. Half of the active subscribers were male (543/1061, 51/3%). The average age of active subscribers was 17; very few (n = 12, 1.1%) were aged less than 5; and the highest number (n = 141, 39%) was in the 20-24 age group. Active subscription rates varied significantly by geographic location. 88.4% of active subscribers had a diagnosis of T1DM or equivalent inscribed on their emblem, while engraved instructions for management in an emergency were only included in 1.8% of records (n = 19). CONCLUSIONS Medical jewellery subscription rates were lower than expected; increased with age; and varied significantly by state/territory. The use of medical identification jewellery may be limited by the lack of suitable engraved instructions for use in an emergency. Factors leading to low use should be addressed. Photo 1 Medical Jewellery with emblem.
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Affiliation(s)
- Madeleine Heath
- School of Medicine Sydney, The University of Notre Dame, Australia, Sydney, NSW, Australia.
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
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Kalra S, Unnikrishnan AG, Prasanna Kumar KM, Sahay R, Chandalia HB, Saboo B, Annamalai S, Kesavadev J, Shukla R, Wangnoo SK, Baruah MP, Jacob J, Arora S, Singla R, Sharma SK, Damodaran S, Bantwal G. Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India. Diabetes Ther 2023; 14:29-45. [PMID: 36380217 PMCID: PMC9880128 DOI: 10.1007/s13300-022-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.
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Goh KG, Zakaria MH, Raja Azwan RN, Bhajan Singh KK, Badrul Hisham MH, Hussein Z. Effect of empagliflozin in patients with type 2 diabetes during Ramadan on volume status, ketonaemia, and hypoglycaemia. Diabetes Metab Syndr 2023; 17:102680. [PMID: 36473336 DOI: 10.1016/j.dsx.2022.102680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Patients with type 2 diabetes (T2D) carry higher risk of glycaemic variability during Ramadan. Glucose-lowering medications such as SGLT2 inhibitors are also associated with genitourinary infection, acute kidney injury, and euglycaemic diabetic ketoacidosis. Limited data is available on the effects of SGLT2 inhibitors on T2D patients during Ramadan. We investigated effects of empagliflozin use in fasting T2D patients. METHODS This was a prospective cohort study in a single diabetes centre in Malaysia. Empagliflozin group were on study drug for at least three months. For control group, subjects not receiving SGLT2 inhibitors were recruited. Follow-up were performed before and during Ramadan fasting. Anthropometric measurements, blood pressure, renal profile, and blood ketone were recorded during visits. Hypoglycaemia symptoms were assessed via hypoglycaemia symptom rating questionnaire (HypoSRQ). RESULTS We recruited a total of 98 subjects. Baseline anthropometry, blood pressure, and renal parameters were similar in two groups. No significant changes in blood pressure, weight, urea, creatinine, eGFR, or haemoglobin levels during Ramadan was found in either group. Likewise, no difference was detected in blood ketone levels (empagliflozin vs control, 0.17 ± 0.247 mmol/L vs 0.13 ± 0.082 mmol/L, p = 0.304) or hypoglycaemia indices (empagliflozin vs control, 19.1% vs 16%, p = 0.684). CONCLUSIONS Ramadan fasting resulted in weight loss and reduction in eGFR levels in patients with T2D. Empagliflozin use during Ramadan is safe and not associated with increased risk of dehydration, ketosis, or hypoglycaemia. Therefore, empagliflozin is a viable glucose-lowering drug for patients with T2D planning for Ramadan fasting.
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Affiliation(s)
- Kian Guan Goh
- Endocrine Unit, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia.
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Basavarajegowda A, Plakkal N. Transfusion reactions in neonates and pediatrics: How and why are they different? Asian J Transfus Sci 2023; 17:97-102. [PMID: 37188035 PMCID: PMC10180791 DOI: 10.4103/ajts.ajts_27_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 05/17/2023] Open
Abstract
Neonates and children are physically as well as physiologically different from adults. They are immunologically vulnerable, and the effects of transfusion can be longstanding, including with respect to their development. The transfusion reactions in children differ from those in adults in the type of reactions, incidence, and severity. The incidence is more than that in adults for the common type of reactions noted in children. Transfusion reactions are most commonly associated with platelets, followed by plasma and red blood cell transfusions in children. Febrile, allergic, and hypotensive reactions or volume overload are the common types in children. Standardizing pediatric adverse transfusion reaction definitions and criteria are necessary to improve studies and reports. Several modifications are needed to be adapted for transfusing blood products in neonates and children to evade the reactions as much as possible and make transfusion safer in this vulnerable population. This article provides a brief articulation of the transfusion reactions in neonatal and pediatric populations describing how they are different from adults.
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Affiliation(s)
- Abhishekh Basavarajegowda
- Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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