Hypoglycemic Exposure and Risk of Asymptomatic Hypoglycemia in Type 1 Diabetes Assessed by Continuous Glucose Monitoring

Henriksen, Marie Moth; Andersen, Henrik Ullits; Thorsteinsson, Birger; Pedersen‐Bjergaard, Ulrik

doi:10.1210/jc.2018-00142

Cited by 51 publications

(44 citation statements)

References 20 publications

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“…Although hypoglycaemia has been studied during pregnancy, the characteristics of IAH differ from those of a severe isolated hypoglycaemia episode or patient with repeated hypoglycaemia but NAH and this might explain our results. Patients with IAH present a higher number of and time spent in asymptomatic hypoglycaemia events and an attenuated sympathoadrenal response to these episodes than NAH . In a rat model, only a longer time in hypoglycaemia (vs shorter duration) caused fetal eye and skeleton anomalies .…”

Section: Discussionmentioning

confidence: 96%

“…Second, data on the glycaemic profile (including hypoglycaemic events) were only derived from self‐monitoring blood glucose, and the frequency of monitoring was not registered, which might explain the lack of differences between groups in non‐SH events. Glucose profile assessment by continuous glucose monitoring in our study could have helped to obtain more accurate data to confirm whether the IAH group had a higher number of asymptomatic hypoglycaemia, as described in the non‐pregnant population . On the other hand, a subjective questionnaire such as Clarke's test was used to identify IAH subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Frequent and repeated episodes of nonsevere hypoglycaemia (non‐SH) result in the hypoglycaemia unawareness syndrome in one to four patients with T1D. In these patients, the risk of SH is threefold higher . Giménez et al showed that hypoglycaemia not only has acute consequences but also has been associated with long‐term effects such as increased inflammatory markers levels and preclinical atherosclerosis with no differences in the lipid profile …”

Section: Introductionmentioning

confidence: 99%

“…In these patients, the risk of SH is threefold higher. 2,3 Giménez et al showed that hypoglycaemia not only has acute consequences but also has been associated with long-term effects such as increased inflammatory markers levels and preclinical atherosclerosis with no differences in the lipid profile. 4 Studies on hypoglycaemia in patients with T1D who become pregnant are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Perea

Bertran

Bellart

et al. 2019

Diabetes Metabolism Res

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Aim The aim of this study is to evaluate the impact of impaired awareness of hypoglycaemia (IAH) on metabolic control and pregnancy outcomes in women with type 1 diabetes. Material and Methods This was a single‐centre prospective cohort study of singleton pregnant women with type 1 diabetes. IAH was assessed at the first antenatal visit using Clarke's test (score ≥ 3). Data on metabolic control, hypoglycaemic events, and the lipid profile were collected from prior to pregnancy and in each trimester of gestation. Pregnancy outcomes were also recorded. Results A total of 77 patients with type 1 diabetes were included; 24 (31.2%) were classified as having IAH. Compared with the normal awareness of hypoglycaemia (NAH) group, the IAH group did not show differences in HbA1c, weight gain, insulin doses, or severe and nonsevere hypoglycaemia events throughout pregnancy. IAH was associated with higher triglyceride concentrations in the second trimester (IAH: 154.8 ± 61.1 mg/dL, NAH: 128.6 ± 31.2 mg/dL, P = .034) and an increased risk of neonatal respiratory distress (odds ratio [OR] 11.24; 95% CI, 1.01‐124.9, P = .041) in adjusted models. Increased risk of pre‐eclampsia was related to higher second trimester triglyceride concentrations (OR 1.028; 95% CI, 1.004‐1.053, P = .023) adjusted for confounders. Conclusions The IAH was associated with increased risk of neonatal respiratory distress and pre‐eclampsia, despite showing no differences in metabolic control. Hypoglycaemia awareness in the first antenatal visit should be assessed to identify the subgroup of pregnant women with increased risk of complications.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Perea

Bertran

Bellart

et al. 2019

Diabetes Metabolism Res

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“…Continuous glucose monitoring systems provide an alternative strategy for monitoring subcutaneous glucose levels [52]. The reliability of continuous glucose monitoring has not been established in CHI but may ascertain trends at night.…”

Section: Monitoring Treatment Efficacymentioning

confidence: 99%

Therapies and outcomes of congenital hyperinsulinism‐induced hypoglycaemia

et al. 2018

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Congenital hyperinsulinism is a rare disease, but is the most frequent cause of persistent and severe hypoglycaemia in early childhood. Hypoglycaemia caused by excessive and dysregulated insulin secretion (hyperinsulinism) from disordered pancreatic β cells can often lead to irreversible brain damage with lifelong neurodisability. Although congenital hyperinsulinism has a genetic cause in a significant proportion (40%) of children, often being the result of mutations in the genes encoding the KATP channel (ABCC8 and KCNJ11), not all children have severe and persistent forms of the disease. In approximately half of those without a genetic mutation, hyperinsulinism may resolve, although timescales are unpredictable. From a histopathology perspective, congenital hyperinsulinism is broadly grouped into diffuse and focal forms, with surgical lesionectomy being the preferred choice of treatment in the latter. In contrast, in diffuse congenital hyperinsulinism, medical treatment is the best option if conservative management is safe and effective. In such cases, children receiving treatment with drugs, such as diazoxide and octreotide, should be monitored for side effects and for signs of reduction in disease severity. If hypoglycaemia is not safely managed by medical therapy, subtotal pancreatectomy may be required; however, persistent hypoglycaemia may continue after surgery and diabetes is an inevitable consequence in later life. It is important to recognize the negative cognitive impact of early‐life hypoglycaemia which affects half of all children with congenital hyperinsulinism. Treatment options should be individualized to the child/young person with congenital hyperinsulinism, with full discussion regarding efficacy, side effects, outcomes and later life impact.

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Definitions and reporting of hypoglycaemia in trials of long-acting insulin analogues in people with type 1 diabetes mellitus

Ipsen

Hemmingsen

Petersen

et al. 2020

Cochrane Database of Systematic Reviews

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Hypoglycemic Exposure and Risk of Asymptomatic Hypoglycemia in Type 1 Diabetes Assessed by Continuous Glucose Monitoring

Abstract: Patients with T1D with hypoglycemic rates corresponding to daily exposure had an increased fraction of asymptomatic events, which was positively associated with risk for severe hypoglycemia; therefore, such patients deserve particular attention in clinical practice.

Cited by 51 publications

References 20 publications

Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Impaired awareness of hypoglycaemia: A new risk factor for adverse pregnancy outcomes in type 1 diabetes

Therapies and outcomes of congenital hyperinsulinism‐induced hypoglycaemia

Definitions and reporting of hypoglycaemia in trials of long-acting insulin analogues in people with type 1 diabetes mellitus

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