Influence of caffeine on the frequency and perception of hypoglycemia in free-living patients with type 1 diabetes.

Watson, Joanne; Jenkins, Emma; Hamilton, Paul; Lunt, M. J.; Kerr, David

doi:10.2337/diacare.23.4.455

Cited by 53 publications

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“…Long-term use of theophylline (and related methylxanthine derivatives) is subject to the emergence of tolerance for many of its effects (31). Although there are indications that tolerance remains incomplete under hypoglycemic conditions (12), this issue needs to be further explored. Appropriate studies are therefore required to establish the clinical potential of theophylline in the management of hypoglycemia unawareness.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, by blocking adenosine-induced maintenance of vascular tone, they reduce cerebral blood flow (CBF), enabling faster perception of decreasing plasma glucose levels and earlier initiation of metabolic and symptom responses. The concept of improved hypoglycemia awareness by adenosine-receptor antagonism has already been successfully tested in humans (9,11,12). However, studies in type 1 diabetic patients with proven hypoglycemia unawareness are still lacking.…”

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confidence: 99%

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Theophylline Improves Hypoglycemia Unawareness in Type 1 Diabetes

Galan¹,

Tack²,

Lenders³

et al. 2002

Diabetes

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Iatrogenic hypoglycemias and the subsequent occurrence of hypoglycemia unawareness are well-known complications of intensive insulin therapy in type 1 diabetic patients that limit glycemic management. From a pharmacological point of view, the adenosine-receptor antagonist theophylline might be beneficial in the management of hypoglycemia unawareness. Theophylline stimulates the release of catecholamines and reduces cerebral blood flow, thereby facilitating stronger metabolic responses to and a prompter perception of decreasing glucose levels. To test the effect of theophylline on responses to hypoglycemia, we performed paired hyperinsulinemic-hypoglycemic clamp studies in 15 diabetic patients with hypoglycemia unawareness and 15 matched healthy control subjects. In random order, we concurrently infused either theophylline or placebo. Measurements included counterregulatory hormones, symptoms, hemodynamic parameters, and sweat detection using a dew-point electrode. Additionally, middle cerebral artery velocities (V MCA ) using transcranial Doppler were monitored as an estimate of cerebral blood flow. When compared with placebo, theophylline significantly enhanced responses of plasma epinephrine, norepinephrine, and cortisol levels in both diabetic patients and control subjects. Because of the theophylline, sweat production started at ϳ0.3 mmol/l higher glucose levels in both groups (P < 0.01), and symptom scores in diabetic patients approached those in control subjects. Theophylline decreased V MCA in both groups (P < 0.001), but significantly greater in diabetic patients (P < 0.01), and prevented the hypoglycemia-induced increase of V MCA that occurred during the placebo studies. We conclude that theophylline improves counterregulatory responses to and perception of hypoglycemia in diabetic patients with impaired awareness of hypoglycemia. Diabetes 51:790 -796, 2002

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Theophylline Improves Hypoglycemia Unawareness in Type 1 Diabetes

Galan¹,

Tack²,

Lenders³

et al. 2002

Diabetes

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“…Previously we have shown that ingestion of modest amounts of caffeine (equivalent to three to four cups of dripbrewed coffee each day) augments the symptomatic and hormonal responses to hypoglycemia in healthy volunteers (15) and patients with type 1 diabetes (6). The beneficial effect of caffeine on hypoglycemia risk is independent of a change in glycemic control (16). Here, using continuous interstitial glucose monitoring, we have shown that caffeine may also be beneficial by reducing the frequency of moderate episodes (Ͻ53 mg/dl) of hypoglycemia occurring at night.…”

Section: Resultsmentioning

confidence: 82%

Influence of Caffeine on Frequency of Hypoglycemia Detected by Continuous Interstitial Glucose Monitoring System in Patients With Long-Standing Type 1 Diabetes

et al. 2005

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OBJECTIVE -The aim of this study was to investigate the effect of caffeine (in doses equivalent to normal daily ingestion) on rates and severity of hypoglycemia in patients with longstanding type 1 diabetes to determine the relationship between caffeine, autonomic function, and hypoglycemia.RESEARCH DESIGN AND METHODS -Using a double-blinded randomized study, we investigated the effect of caffeine versus placebo in 19 patients with long-standing type 1 diabetes using continuous glucose sensing technology and simultaneous assessment of autonomic function using Holter monitoring.RESULTS -Caffeine reduced the duration of nocturnal hypoglycemia with a mean duration of 49 minutes (range 0 -235) versus 132 (0 -468) minutes (P ϭ 0.035). The reduction in duration of nighttime hypoglycemia was due to a decline in the number of episodes of moderate hypoglycemia at the expense of mild hypoglycemic episodes (P ϭ 0.04). There was no overall correlation between reduced heart rate variability (a marker of autonomic dysfunction) and hypoglycemic events (r s ϭ 0.12, P ϭ 0.62).CONCLUSIONS -Our results suggest that caffeine is associated with a significant reduction in nocturnal hypoglycemia. The reduction in nocturnal hypoglycemia was not linked to the concomitant rise in parasympathetic activity associated with caffeine. Diabetes Care 28:1316 -1320, 2005H ypoglycemia and the fear of low blood glucose levels remain ratelimiting factors in achieving normoglycemia for patients with type 1 diabetes (1). A number of irreversible factors have been implicated in increasing an individual's risk from severe hypoglycemia, including long duration of diabetes, the presence of autonomic neuropathy (2), and sleep. Recently, continuous glucose monitoring systems (CGMSs) have shown that, in adults and children with type 1 diabetes, episodes of prolonged hypoglycemia may be missed (particularly at night) if patients rely solely on warning symptoms or fingerstick blood glucose measurements (3,4).Approaches to reducing hypoglycemia risk have included relaxation of blood glucose targets, a change in class of insulin, and the use of novel insulin delivery systems including insulin pump therapy (5). Previously, we have shown that ingestion of moderate amounts of caffeine also may be useful by augmenting the symptomatic and hormonal responses to mild hypoglycemia, allowing appropriate action to be taken before neuroglycopenia ensues (6). The benefits of regular caffeine ingestion in patients with type 1 diabetes may extend beyond its influence on hypoglycemia warning symptoms. Regular ingestion of modest amounts of caffeine also improves heart rate variability (HRV), a reproducible measure of autonomic function (7). Loss of HRV is associated with a marked increase in the risk of sudden death in both diabetic and nondiabetic populations (8,9).The aim of this study was to examine the influence of regular ingestion of modest amounts of caffeine on the frequency of hypoglycemic episodes and to investigate the possibility of a relationship between the augm...

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“…In a recent report, administration of caffeine increased blood glucose concentrations during the day and augmented postprandial glucose levels when habitual coffee drinkers with type 2 diabetes were monitored during daily life (Lane et al, 2007). In contrast, other studies reported that caffeine substantially lowered the risk of clinical type 2 diabetes (Debrah et al, 1996;Watson and Kerr, 1999;Watson et al, 2000;van dam and Feskens, 2002). Although the influence of caffeine in normal adults and diabetics has been studied, the results are clearly controversial.…”

Section: Discussionmentioning

confidence: 86%

Study on the Postprandial Glucose Responses to a Chlorogenic Acid-Rich Extract of Decaffeinated Green Coffee Beans in Rats and Healthy Human Subjects

Iwai

Narita

Fukunaga

et al. 2012

FSTR

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The objective of this investigation was to assess the antihyperglycemic effects of an extract of decaffeinated green coffee beans (EDGCB). Despite the potential properties attributed to this compound, little is known about its action in vivo. In rats, EDGCB significantly decreased postprandial blood glucose levels when administered with each of the 4 carbohydrate types (sucrose, maltose, glucose, and soluble starch). An optimum effect was observed when EDGCB was administered at the beginning of the carbohydrate challenge. In the clinical trial, plasma glucose levels were significantly reduced by administering doses of 100 and 300 mg EDGCB after ingestion of 200 g carbohydrate, particularly in subjects with a high glycemic response. No significant differences were observed in plasma insulin profiles, however, over the course of the experiment.

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Influence of caffeine on the frequency and perception of hypoglycemia in free-living patients with type 1 diabetes.

Abstract: Figure 3-Change in middle cerebral artery blood velocity during caffeine and placebo supplementation compared with baseline. Male patients (A) and female patients ( B).

Cited by 53 publications

References 0 publications

Theophylline Improves Hypoglycemia Unawareness in Type 1 Diabetes

Theophylline Improves Hypoglycemia Unawareness in Type 1 Diabetes

Influence of Caffeine on Frequency of Hypoglycemia Detected by Continuous Interstitial Glucose Monitoring System in Patients With Long-Standing Type 1 Diabetes

Study on the Postprandial Glucose Responses to a Chlorogenic Acid-Rich Extract of Decaffeinated Green Coffee Beans in Rats and Healthy Human Subjects

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