Association between hypoglycaemia and impaired hypoglycaemia awareness and mortality in people with Type 1 diabetes mellitus

Sejling, Anne‐Sophie; Schouwenberg, B.J.J.W.; Færch, Louise; Thorsteinsson, Birger; Galan, Bastiaan E. de; Pedersen‐Bjergaard, Ulrik

doi:10.1111/dme.12810

Cited by 16 publications

(9 citation statements)

References 33 publications

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“…The data are consistent in patients with type 2 diabetes [8,9]. However, some studies on patients with type 1 diabetes have not documented an association [10], probably reflective of a lower baseline risk of cardiovascular disease in patients with type 1 diabetes.…”

supporting

confidence: 62%

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Jialal

Dhindsa

2016

Atherosclerosis

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supporting

confidence: 62%

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Jialal

Dhindsa

2016

Atherosclerosis

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“…Rodents exposed to recurrent hypoglycemic events of moderate severity were less likely to develop neuronal damage or cognitive impairments or die during subsequent severe hypoglycemia than age-matched littermates who were not pre-exposed to hypoglycemia [ 45 , 46 ]. These data may help to explain recent observations that patients with type 1 diabetes and impaired awareness of hypoglycemia, as a reflection of recurrent hypoglycemia, appeared not at greater risk of dying than patients with intact awareness [ 47 ].…”

Section: Morbidity Associated With Hypoglycemiamentioning

confidence: 84%

Brain glucose metabolism during hypoglycemia in type 1 diabetes: insights from functional and metabolic neuroimaging studies

Rooijackers

Wiegers

Tack

et al. 2015

Cell. Mol. Life Sci.

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Hypoglycemia is the most frequent complication of insulin therapy in patients with type 1 diabetes. Since the brain is reliant on circulating glucose as its main source of energy, hypoglycemia poses a threat for normal brain function. Paradoxically, although hypoglycemia commonly induces immediate decline in cognitive function, long-lasting changes in brain structure and cognitive function are uncommon in patients with type 1 diabetes. In fact, recurrent hypoglycemia initiates a process of habituation that suppresses hormonal responses to and impairs awareness of subsequent hypoglycemia, which has been attributed to adaptations in the brain. These observations sparked great scientific interest into the brain’s handling of glucose during (recurrent) hypoglycemia. Various neuroimaging techniques have been employed to study brain (glucose) metabolism, including PET, fMRI, MRS and ASL. This review discusses what is currently known about cerebral metabolism during hypoglycemia, and how findings obtained by functional and metabolic neuroimaging techniques contributed to this knowledge.

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“…2016). Patients were eligible for the current analysis when the DR screen had take place at the Department of Ophthalmology of the Radboud University Medical Center.…”

Section: Methodsmentioning

confidence: 99%

“…This study was conducted in a cohort of patients with T1DM who were recruited at the outpatient diabetes clinic of the Internal Medicine Department at the Radboud University Medical Center between 2006 and 2008 for a study on hypoglycaemia awareness (Sejling et al 2016). Patients were eligible for the current analysis when the DR screen had take place at the Department of Ophthalmology of the Radboud University Medical Center.…”

Section: Subjectsmentioning

confidence: 99%

Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus

Schreur

Asten

et al. 2018

Acta Ophthalmologica

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PurposeTo investigate risk factors for the development and progression of diabetic retinopathy (DR) and long‐term visual outcomes in Dutch patients with type 1 diabetes mellitus (T1DM).MethodsCumulative incidences were calculated for DR, vision‐threatening DR (VTDR), defined as (pre)proliferative DR and diabetic macular oedema, and best‐corrected visual acuity (BCVA) <0.5 and <0.3 at the most recent eye examination. The following factors were assessed: duration of diabetes, age of onset of T1DM, gender, mean HbA1c, HbA1c variability (defined as coefficient of variation of five separate HbA1c measurements), mean arterial blood pressure, body mass index, albuminuria and lipid profile. We used multivariable Cox regression models to identify factors associated with DR development and progression to VTDR.ResultsWe found 25‐year cumulative incidences of 63% for DR, 21% for VTDR, 2% for BCVA <0.5, and 1% for BCVA <0.3. Mean HbA1c (HR 1.023, p < 0.001), HbA1c variability (HR 1.054, p < 0.001), age of onset of T1DM (HR 1.024, p < 0.001), HDL cholesterol (HR 0.502, p = 0.002) and total cholesterol (HR 1.210, p = 0.029) showed an independent association with faster development of any form of DR. The mean HbA1c (HR 1.023, p < 0.001) and the presence of albuminuria (HR 2.940, p = 0.028) were associated with faster progression to VTDR.ConclusionThese data show relatively low cumulative incidences of DR, VTDR and visual impairment. Higher mean HbA1c, HbA1c variability, age of onset of T1DM and total cholesterol were independently associated with the risk of DR development, and a protective association was found for HDL cholesterol in subjects with T1DM. Mean HbA1c and presence of albuminuria were associated with progression of DR.

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Association between hypoglycaemia and impaired hypoglycaemia awareness and mortality in people with Type 1 diabetes mellitus

Abstract: Severe hypoglycaemia and hypoglycaemia unawareness are not associated with increased risk of all-cause or cardiovascular mortality in people with Type 1 diabetes mellitus.

Cited by 16 publications

References 33 publications

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Hypoglycemia and the predisposition to cardiovascular disease: Is the pro-inflammatory-pro-coagulant diathesis a plausible explanation?

Brain glucose metabolism during hypoglycemia in type 1 diabetes: insights from functional and metabolic neuroimaging studies

Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus

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