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In 1959, Michael Somogyi reported that hypoglycaemia during the night was often followed by heavy glycosuria next morning [1]. Moreover, a high morning fasting blood glucose value was later attributed to nocturnal hypoglycaemia and the need to reduce the evening or bedtime dose of insulin. The Somogyi phenomenon-hypoglycaemia begetting hyperglycaemia-is believed to be due to the release of counterregulatory hormones in response to (nocturnal) insulin-induced hypoglycaemia. Despite the fact that experimental studies have rejected the existence of the Somogyi phenomenon [2][3][4], it is, in our experience, still widely believed to exist by health care professionals. Previous experimental research has been based on hospitalised patients using nocturnal blood glucose profiles or real life data with a single nocturnal blood glucose measurement. The sensitivity of the latter method for the detection of nocturnal hypoglycaemia is low [3,5], which may explain some of the reluctance to accept that the phenomenon does not exist. The recent development of continuous glucose monitoring systems has made it possible to monitor patients with type 1 diabetes in daily life.Using this technology, we tested the existence of the Somogyi phenomenon in daily life in a large cohort of type 1 diabetic subjects.All 262 patients with type 1 diabetes from a cohort included in a study of hypoglycaemia in 1999 [6] were invited to participate in a prospective observational study in 2002. The protocol was approved by the regional ethics committee. Of the patients invited, 126 (48%) gave written informed consent to participate, while four (2%) were dead, 23 (9%) had moved or did not participate for other specific reasons, 37 (14%) did not respond to the invitation, and 72 (27%) declined to participate. The participants (35% women ) had a mean (SD) age of 46 (12) years and a diabetes duration of 21 (12) years. Most (86%) of the patients were on basal bolus treatment with NPH and human insulin. The remaining patients were receiving one-or two-dose therapy, and the mean HbA 1 c was 8.5±1.0%. Patients underwent 6 days of continuous subcutaneous glucose monitoring using a continuous glucose monitoring system (CGMS) (Medtronic MiniMed; Medtronic Diabetes, Northridge, CA, USA). At day 1, the sensor was inserted into the abdominal wall. Following careful instruction about the device and protocol, initial calibration was performed and patients went home with instructions to live as normally as possible. At day 4, the sensors were replaced, and at day 7 the sensors were dismantled and data were analysed. Calibration measurements were performed four times daily with a glucose analyser (HemoCue B; HemoCue, Vedbaek, Denmark) in order to obtain optimal accuracy of the calibration curve. The glucose analysers used in the present study were calibrated identically by the manufacturer. Participants kept a diary during the entire study period, documenting insulin doses, meals and snacks, episodes of symptomatic hypoglycaemia, and the blood glucose level during t...

Hypoglycaemic episodes recorded by CGMS are reproducible and agreement with independent SMBG values is acceptable for retrospective recording of hypoglycaemic events with CGMS.

Objective. Using biomarkers for early and accurate identification of patients at low risk of serious illness may improve the flow in the emergency department (ED) by classifying these patients as nonurgent or even suitable for discharge. A potential biomarker for this purpose is soluble urokinase plasminogen activator receptor (suPAR). We hypothesized that availability of suPAR might lead to a higher proportion of early discharges. Design. A substudy of the interventional TRIAGE III trial, comparing patients with a valid suPAR measurement at admission to those without. The primary endpoint was the proportion of patients discharged alive from the ED within 24 hours. Secondary outcomes were length of hospital stay, readmissions, and mortality within 30 days. Setting. EDs at two university hospitals in the Capital Region of Denmark. Participants. 16,801 acutely admitted patients were included. Measurements and Main Results. The suPAR level was available in 7,905 patients (suPAR group), but not in 8,896 (control group). The proportion of patients who were discharged within 24 hours of admittance was significantly higher in the suPAR group compared to the control group (50.2% (3,966 patients) vs. 48.6% (4,317 patients), P=0.04). Furthermore, the mean length of hospital stay in the suPAR group was significantly shorter compared to that in the control group (4.3 days (SD 7.4) vs. 4.6 days (SD 9.4), P=0.04). In contrast, the readmission rate within 30 days was significantly higher in the suPAR group (10.6% (839 patients) vs. 8.8% (785 patients), P<0.001). Among patients discharged within 24 hours, there was no significant difference in the readmission rate or mortality within 30 days. Readmission occurred in 8.5% (336 patients) vs. 7.7% (331 patients) (P=0.18) and mortality in 1.3% (52 patients) vs. 1.8% (77 patients) (P=0.08) for the suPAR group and control group, respectively. Conclusion. These post hoc analyses demonstrate that the availability of the prognostic biomarker suPAR was associated with a higher proportion of discharge within 24 hours and reduced length of stay, but more readmissions. In patients discharged within 24 hours, there was no difference in readmission or mortality. Trial Registration of the Main Trial. This trial is registered with NCT02643459.