Continuous glucose monitoring for hypoglycemia avoidance and glucose counterregulation in long-standing type 1 diabetes
MR Rickels, AJ Peleckis, C Dalton-Bakes… - The Journal of …, 2018 - academic.oup.com
MR Rickels, AJ Peleckis, C Dalton-Bakes, JR Naji, NA Ran, HL Nguyen, S O'Brien, S Chen…
The Journal of Clinical Endocrinology & Metabolism, 2018•academic.oup.comContext Patients with long-standing type 1 diabetes (T1D) are at increased risk for severe
hypoglycemia because of defects in glucose counterregulation and recognition of
hypoglycemia symptoms, in part mediated through exposure to hypoglycemia. Objective To
determine whether implementation of real-time continuous glucose monitoring (CGM) as a
strategy for hypoglycemia avoidance could improve glucose counterregulation in patients
with long-standing T1D and hypoglycemia unawareness. Design, Setting, Participants, and …
hypoglycemia because of defects in glucose counterregulation and recognition of
hypoglycemia symptoms, in part mediated through exposure to hypoglycemia. Objective To
determine whether implementation of real-time continuous glucose monitoring (CGM) as a
strategy for hypoglycemia avoidance could improve glucose counterregulation in patients
with long-standing T1D and hypoglycemia unawareness. Design, Setting, Participants, and …
Context
Patients with long-standing type 1 diabetes (T1D) are at increased risk for severe hypoglycemia because of defects in glucose counterregulation and recognition of hypoglycemia symptoms, in part mediated through exposure to hypoglycemia.
Objective
To determine whether implementation of real-time continuous glucose monitoring (CGM) as a strategy for hypoglycemia avoidance could improve glucose counterregulation in patients with long-standing T1D and hypoglycemia unawareness.
Design, Setting, Participants, and Intervention
Eleven patients with T1D disease duration of ∼31 years were studied longitudinally in the Clinical & Translational Research Center of the University of Pennsylvania before and 6 and 18 months after initiation of CGM and were compared with 12 nondiabetic control participants.
Main Outcome Measure
Endogenous glucose production response derived from paired hyperinsulinemic stepped-hypoglycemic and euglycemic clamps with infusion of 6,6-2H2-glucose.
Results
In patients with T1D, hypoglycemia awareness (Clarke score) and severity (HYPO score and severe events) improved (P < 0.01 for all) without change in hemoglobin A1c (baseline, 7.2% ± 0.2%). In response to insulin-induced hypoglycemia, endogenous glucose production did not change from before to 6 months (0.42 ± 0.08 vs 0.54 ± 0.07 mg·kg−1·min−1) but improved after 18 months (0.84 ± 0.15 mg·kg−1·min−1; P < 0.05 vs before CGM), albeit remaining less than in controls (1.39 ± 0.11 mg·kg−1·min−1; P ≤ 0.01 vs all).
Conclusions
Real-time CGM can improve awareness and reduce the burden of problematic hypoglycemia in patients with long-standing T1D, but with only modest improvement in the endogenous glucose production response that is required to prevent or correct low blood glucose.
Oxford University Press