Classification of hypoglycemia awareness in people with type 1 diabetes in clinical practice

Høi-Hansen, Thomas; Pedersen‐Bjergaard, Ulrik; Thorsteinsson, Birger

doi:10.1016/j.jdiacomp.2009.07.006

Cited by 53 publications

(46 citation statements)

References 15 publications

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“…Moreover, classification of awareness status was based upon three validated methods (40), resulting in two clearly separated groups as subsequently confirmed by the differences in hypoglycemia symptom scores during hypoglycemia as well as in the counterregulatory responses. CGM was also applied in order to avoid any symptomatic and asymptomatic hypoglycemia 5 days prior to the study, which could potentially blunt the symptomatic and hormonal responses to hypoglycemia induced during the study (34).…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia-Associated Changes in the Electroencephalogram in Patients With Type 1 Diabetes and Normal Hypoglycemia Awareness or Unawareness

et al. 2014

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Hypoglycemia is associated with increased activity in the low-frequency bands in the electroencephalogram (EEG). We investigated whether hypoglycemia awareness and unawareness are associated with different hypoglycemia-associated EEG changes in patients with type 1 diabetes. Twenty-four patients participated in the study: 10 with normal hypoglycemia awareness and 14 with hypoglycemia unawareness. The patients were studied at normoglycemia (5–6 mmol/L) and hypoglycemia (2.0–2.5 mmol/L), and during recovery (5–6 mmol/L) by hyperinsulinemic glucose clamp. During each 1-h period, EEG, cognitive function, and hypoglycemia symptom scores were recorded, and the counterregulatory hormonal response was measured. Quantitative EEG analysis showed that the absolute amplitude of the θ band and α-θ band up to doubled during hypoglycemia with no difference between the two groups. In the recovery period, the θ amplitude remained increased. Cognitive function declined equally during hypoglycemia in both groups and during recovery reaction time was still prolonged in a subset of tests. The aware group reported higher hypoglycemia symptom scores and had higher epinephrine and cortisol responses compared with the unaware group. In patients with type 1 diabetes, EEG changes and cognitive performance during hypoglycemia are not affected by awareness status during a single insulin-induced episode with hypoglycemia.

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Section: Discussionmentioning

confidence: 99%

Hypoglycemia-Associated Changes in the Electroencephalogram in Patients With Type 1 Diabetes and Normal Hypoglycemia Awareness or Unawareness

et al. 2014

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“…Clinical scoring of symptoms has been developed (66)(67)(68). Because impaired awareness is inducible and reversible, such a classification cannot be assumed to be stable.…”

Section: Pathophysiology Of Hypoglycemiamentioning

confidence: 99%

Minimizing Hypoglycemia in Diabetes

2015

Diabetes Care

159

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Hypoglycemia caused by treatment with a sulfonylurea, a glinide, or insulin coupled with compromised defenses against the resulting falling plasma glucose concentrations is a problem for many people with diabetes. It is often recurrent, causes significant morbidity and occasional mortality, limits maintenance of euglycemia, and impairs physiological and behavioral defenses against subsequent hypoglycemia. Minimizing hypoglycemia includes acknowledging the problem; considering each risk factor; and applying the principles of intensive glycemic therapy, including drug selection and selective application of diabetes treatment technologies. For diabetes health-care providers treating most people with diabetes who are at risk for or are suffering from iatrogenic hypoglycemia, these principles include selecting appropriate individualized glycemic goals and providing structured patient education to reduce the incidence of hypoglycemia. This is typically combined with short-term scrupulous avoidance of hypoglycemia, which often will reverse impaired awareness of hypoglycemia. Clearly, the risk of hypoglycemia is modifiable.Hypoglycemia is the major limiting factor in the glycemic management of diabetes with a sulfonylurea, a glinide, or insulin (1,2). It is often recurrent, causes significant morbidity in most people with type 1 diabetes and in many with advanced type 2 diabetes (i.e., those with absolute endogenous insulin deficiency), and is sometimes fatal. Hypoglycemia limits maintenance of euglycemia over a lifetime of diabetes and, thus, generally prevents full realization of the benefits of glycemic control. It impairs defenses against subsequent falling plasma glucose concentrations and can cause impaired awareness of hypoglycemia, therefore resulting in a vicious cycle of recurrent hypoglycemia.The problem of hypoglycemia in diabetes has been recently reviewed in detail (1,2). The intent of this article is not to reiterate that information but, rather, to summarize the relevant background and then focus on pragmatic approaches to minimizing hypoglycemia. Efforts to minimize hypoglycemia include acknowledging the problem, considering each risk factor, and applying the relevant principles of intensive glycemic therapy (3-6). The principles of intensive glycemic therapy include avoiding sulfonylureas and glinides; using more physiological insulin regimens, such as insulin analogs, when insulin is indicated; ensuring users are confident in their self-management; considering insulin treatment technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and CSII with CGM (ideally with suspension of insulin infusion when glucose levels fall to a selected low value) for selected patients; and closed-loop insulin or insulin and glucagon replacement or pancreas or pancreatic islet transplantation for the few patients in whom hypoglycemia persists. However, for the majority of people with diabetes who are at risk for or are suffering from iatrogenic hypoglycemia, the principle...

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“…Patients answering "always" were categorized as being "aware", those answering "usually" as having "impaired awareness" and those answering "occasionally" or "never" as being "unaware" [10]. This method was chosen because it is simple and is proven to be equal to other methods to assess the state of awareness [11]. The Regional Committee on Biomedical Research Ethics approved the study and written informed consent was obtained from all participants.…”

Section: • Subjectsmentioning

confidence: 99%

Recurrent severe hypoglycemia in Type 1 diabetes: potential for prevention?

Henriksen¹,

Due-Andersen²,

Thorsteinsson³

et al. 2014

Diabetes Management

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Aim: To compare characteristics of solitary and recurrent episodes of severe hypoglycemia in order to explore the potential for prevention of recurrent severe hypoglycemia (SH) in a cohort of patients with Type 1 diabetes. Methods: 230 patients with Type 1 diabetes were followed prospectively for 1 year and reported characteristics of SH within 24 h. Results: 239 episodes of SH were reported by 86 patients, corresponding to 1.0 episode per patient year; 82% of the episodes were recurrent (≥2 episodes per patient year). Compared with solitary SH, recurrent SH occurred more often during daytime, primarily in subjects with reduced hypoglycemia awareness, and were characterized by absence of warning symptoms. Conclusion: A large proportion of SH in Type 1 diabetes is recurrent and thereby potentially preventable. Focus should be directed towards patients with reduced hypoglycemia awareness. Summary points Results

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Classification of hypoglycemia awareness in people with type 1 diabetes in clinical practice

Cited by 53 publications

References 15 publications

Hypoglycemia-Associated Changes in the Electroencephalogram in Patients With Type 1 Diabetes and Normal Hypoglycemia Awareness or Unawareness

Hypoglycemia-Associated Changes in the Electroencephalogram in Patients With Type 1 Diabetes and Normal Hypoglycemia Awareness or Unawareness

Minimizing Hypoglycemia in Diabetes

Recurrent severe hypoglycemia in Type 1 diabetes: potential for prevention?

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