Does Brittle Diabetes Exist?

Gill, Geoffrey

doi:10.1002/9780470757109.ch10

Cited by 6 publications

(5 citation statements)

References 61 publications

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“…Measuring lability is always difficult, it has even been suggested that the simple measure of the thickness of the patient chart provides an indication of the patient with brittle diabetes (12). Health care professionals who routinely deal with type 1 diabetes can judge if someone has labile diabetes, but quantifying it is a challenge.…”

Section: Discussionmentioning

confidence: 99%

“…However, subjects can have longer periods of stable and unstable glucose control. Patients may have wide oscillations in their glucose values and, when severe, especially if associated with disruption of lifestyle, may be labeled "brittle," but there has been difficulty in the definition of this term (12). HbA 1c is often only slightly elevated because the low glucose values offset the high numbers.…”

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confidence: 99%

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Assessment of the Severity of Hypoglycemia and Glycemic Lability in Type 1 Diabetic Subjects Undergoing Islet Transplantation

et al. 2004

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Currently, the major indications for solitary islet transplantation are recurrent severe hypoglycemia and labile glucose control. Quantifying these problems remains subjective. We have developed a scoring system for both hypoglycemia and glycemic lability, established normative data, and used them in patients who have undergone islet transplantation. A composite hypoglycemic score (HYPO score) was devised based on the frequency, severity, and degree of unawareness of the hypoglycemia. In addition, using 4 weeks of glucose records, a lability index (LI) was calculated based on the change in glucose levels over time and compared with a clinical assessment of glycemic lability. A mean amplitude of glycemic excursions (MAGE) was also calculated based on 2 consecutive days of seven readings each day. These scores were determined in 100 randomly selected subjects with type 1 diabetes from our general clinic to serve as a control group and in patients before and after islet transplantation. The mean age of the control diabetic subjects was 38.4 ؎ 1.3 years (؎SE), with a duration of diabetes of 21.5 ؎ 1.1 years. The median HYPO score in the control subjects was 143 (25th to 75th interquartile range: 46 -423). The LI in the diabetic control subjects was 223 (25th to 75th interquartile range: 130 -329 mmol/l 2 /h ⅐ week ؊1 ). The LI correlated much more closely than the MAGE with the clinical assessment of lability. A HYPO score of >1,047 (90th percentile) or an LI >433 mmol/l 2 / h ⅐ week ؊1 (90th percentile) indicated serious problems with hypoglycemia or glycemic lability, respectively. The islet transplant patients (n ‫؍‬ 51) were 42.1 ؎ 1.4 years old, with a duration of diabetes of 25.7 ؎ 1.4 years. Islet transplant patients had a mean HYPO score of 1,234 ؎ 184 pretransplant, which was significantly higher than that of the control subjects (P < 0.001), which became negligible posttransplantation with the elimination of hypoglycemia. The median LI pretransplant was 497 mmol/l 2 /h ⅐ week ؊1 (25th to 75th interquartile range: 330 -692), significantly higher than that of control subjects (P < 0.001), and fell to 40 (25th to 75th interquartile range: 14 -83) within a month after the final transplant. In those who had lost graft function, the LI rose again. The HYPO score and LI provide measures of the extent of problems with hypoglycemia and glycemic lability, respectively, complement the clinical assessment of the problems with glucose control before islet transplantation, and will allow comparison of selection of subjects for transplants between centers. Diabetes 53:955-962, 2004 P atients with type 1 diabetes have to balance the risks of long-term hyperglycemia and its consequences versus the acute risk of hypoglycemia. The Diabetes Control and Complications Trial has confirmed that achieving strict glycemic control is worthwhile but comes with the price of a threefold increased risk of severe hypoglycemia (1). In addition to long-term consequences (2), such hypoglycemia comes with costs in the short term as evidenced...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Assessment of the Severity of Hypoglycemia and Glycemic Lability in Type 1 Diabetic Subjects Undergoing Islet Transplantation

et al. 2004

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“…Although there is persuasive evidence that insulin cessation or underdosing may be a major cause of recurrent DKA,4,6,7 it is interesting that only two of the 10 admitted to such manipulative behaviour during their period of brittleness, and one woman remained angry about these allegations. We wondered whether this small number (20%) openly discussing therapeutic manipulation may have been because of the frequent presence of a relative (four out of 10 interviewees), as other studies have suggested at least a 50% rate of proven or admitted manipulation of treatment 5,10.…”

Section: Discussionmentioning

confidence: 99%

“…Tattersall's definition of 1977 remains valuable – ‘those whose lives are disrupted by periods of hypo or hyperglycaemia whatever the cause’,1 and most recognise still ‘life disruption’ as one of the hallmarks of the condition. More recently, recurrent and/or prolonged hospital admissions have become accepted as a further constant feature of brittleness 2–4…”

Section: Introductionmentioning

confidence: 99%

Life quality and experience among long‐term survivors of brittle type 1 diabetes mellitus

et al. 2011

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Severely unstable, or ‘brittle’, type 1 diabetes is characterised by recurrent admissions, usually in diabetic ketoacidosis and life disruption. It is associated with excess mortality and increased risk of diabetic complications. The long‐term social and life effects of survivors have not, however, been previously explored. The aim of our study was to determine the long‐term effects of a period of brittle control on life quality and psychosocial morbidity. We identified 10 survivors of an original cohort of 33 brittle type 1 patients, recruited between 1979 and 1985. All were visited by a diabetes research nurse, and a semi‐quantitative interview was conducted, and quantitative quality of life (QOL) assessment made. QOL data were compared with a case‐control group (two controls per case) matched for age, sex and diabetes duration; but without a history of brittle control. All of the 10 survivors were female; mean age was 42±4 years and diabetes duration 32±5 years. The mean period of follow up was 22 years. Four (40%) had active psychiatric disease (two depression, one depression and schizophrenia, and one eating disorder). Most attributed their previous instability to life stresses and/or inadequate diabetes‐related education. Two (20%) admitted to inducing dysglycaemia by therapeutic interference. Five were in a stable relationship and three had children. None of the survivors was actively brittle, and most attributed resolution of brittleness to positive life changes. Total QOL score was lower (i.e. worse) in the brittle compared with the stable group (p=0.046). We conclude that survivors of brittle type 1 diabetes have significant psychosocial morbidity and reduced life quality. This emphasises the adverse long‐term effects of brittle diabetes, even when glycaemic stability has been restored. Copyright © 2011 John Wiley & Sons.

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“…Replacement glucocorticoid treatment abolished the hypoglycaemic instability. Though most severely unstable or 'brittle' diabetes has behavioural and psychosocial origins, organic conditions must always be considered; especially in the less common brittle syndrome of recurrent hypoglycaemia 2 . In a national UK survey of brittle diabetes, we found only 17% of all brittle patients to have recurrent hypoglycaemia, and of the 64 patients affected one was reported to have hypoadrenalism due to pituitary hypofunction 3 .…”

Section: Letters On Any Aspect Of Diabetes Care Are Welcomed and Shoumentioning

confidence: 99%

Recurrent hypoglycaemia in a patient with history of brittle diabetes

Gill

2001

Pract Diab Int

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Does Brittle Diabetes Exist?

Cited by 6 publications

References 61 publications

Assessment of the Severity of Hypoglycemia and Glycemic Lability in Type 1 Diabetic Subjects Undergoing Islet Transplantation

Assessment of the Severity of Hypoglycemia and Glycemic Lability in Type 1 Diabetic Subjects Undergoing Islet Transplantation

Life quality and experience among long‐term survivors of brittle type 1 diabetes mellitus

Recurrent hypoglycaemia in a patient with history of brittle diabetes

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