Glucagon Underutilized Among Type 1 Diabetes Mellitus Patients in Japan

Abstract

Glucagon as a measure to treat severe hypoglycemia was underutilized among T1DM patients in Japan.

Usability of Nasal Glucagon Device: Partially Randomized Caregiver and Third-Party User Experience Trial with Simulated Administration at a Japanese Site

“…These results are consistent with those of the Canadian simulation study [15], as well as those of real-world studies of the NG device, in which participants indicated that the device was easy to use [13,14]. The possession rate for glucagon among patients with T1D in Japan is reportedly very low (15.9%), mostly because patients do not think they will need glucagon, but also because of reluctance by family members to inject [9]. Higher glucagon possession rates have been reported in Australia (92%) [8], Israel (60%) [17], Croatia (45%) [18], and the USA (49%) [19]; this difference may reflect the lack of a glucagon kit in Japan, the older age of patients in this study (most other studies were of pediatric patients), or cultural factors.…”

“…Most caregivers and third parties could use the NG device correctly and reported that they were confident in its use. These results suggest that the availability of a ready-to-use form of glucagon (i.e., NG device) in Japan may increase the number of patients with diabetes who keep glucagon on hand in case of emergency [9].…”

“…This increases the complexity of preparing glucagon for intramuscular injection and may also increase the chance of mistakenly administering other drugs such as insulin in an emergency. The reluctance of caregivers to inject glucagon may contribute to the low possession rate for glucagon in Japan [9].…”

Role of glucagon in treating diabetes: Evidence and concepts (胰高血糖素在糖尿病治疗中的作用：证据与概念)

“…Some of the above considerations offer a mechanism for the reduced glucagon response to hypoglycemia beginning early in the course of type 1 diabetes, and glucagon has long been appreciated to have a potential therapeutic role given the 20–30% annual likelihood of severe hypoglycemia in type 1 diabetes, although this treatment is actually used by relatively few type 1 diabetic patients . New approaches to closed‐loop pump treatment have made use of dual infusion of glucagon as well as insulin in reducing the likelihood of hypoglycemia .…”

“…21 Some of the above considerations offer a mechanism for the reduced glucagon response to hypoglycemia beginning early in the course of type 1 diabetes, 23 and glucagon has long been appreciated to have a potential therapeutic role given the 20-30% annual likelihood of severe hypoglycemia in type 1 diabetes, 24 although this treatment is actually used by relatively few type 1 diabetic patients. 25 New approaches to closed-loop pump treatment have made use of dual infusion of glucagon as well as insulin in reducing the likelihood of hypoglycemia. 26 Some studies of incretin-based treatment of type 1 diabetes have shown glycemic benefit [27][28][29] and, although this has not been demonstrated in all trials, 30 a potential explanation has been observed in that dipeptidyl peptidase-4 inhibition appears to reduce glucagon levels in type 1 diabetic patients in the setting of hyperglycemia 19,31 and in the postprandial period while not giving rise to a decreased glucagon response to hypoglycemia.…”