Effects of Acute Insulin-Induced Hypoglycemia on Indices of Inflammation

Wright, Rohana J.; Newby, David E.; Stirling, David; Ludlam, Christopher A.; Macdonald, I. A.; Frier, Brian M.

doi:10.2337/dc10-0013

Cited by 178 publications

(152 citation statements)

References 25 publications

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“…Acute, insulin-induced hypoglycemia has been shown in numerous studies to induce a proinflammatory state. Increased levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), reactive oxygen species, and adhesion molecules have detrimental effects on the vascular endothelium leading to increased atherosclerotic plaque formation [17][18][19]. Numerous changes are also observed in hemostatic proteins leading to a prothrombotic environment, which are further detailed later.…”

Section: Mechanisms Linking Hypoglycemia and Cardiovascular Diseasementioning

confidence: 99%

Hypoglycaemia, thrombosis and vascular events in diabetes

King

Ajjan

2016

Expert Review of Cardiovascular Therapy

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Section: Mechanisms Linking Hypoglycemia and Cardiovascular Diseasementioning

confidence: 99%

Hypoglycaemia, thrombosis and vascular events in diabetes

King

Ajjan

2016

Expert Review of Cardiovascular Therapy

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“…A potential risk of this approach is that hypoglycemia in general is suggested to be related to a higher risk of micro and macrovascular complications. 18,19 When studying subjects under hypoglycemic conditions in a trial, the clamp method with relatively stable glucose concentrations around 60 mg/dL may however be considered one of the safer alternatives compared to those that induce short swings with low blood glucose concentrations in a less controlled manner.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Performance Evaluation of Five Blood Glucose Systems in the Hypo-, Eu-, and Hyperglycemic Range

Zijlstra

Heinemann

Fischer

et al. 2016

J Diabetes Sci Technol

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The performance of blood glucose (BG) measurement systems (BG meters plus test strips) is a much debated and researched topic. Reliable BG measurements are needed to ensure that patients with diabetes make the same clinical decisions (eg, select appropriate insulin dose) as they would do if the glucose measurements were made with a laboratory or even better with a reference method. 1 BG systems are considered accurate if they show high precision and high trueness, that is, both the random error (measurement imprecision or variability) and the systematic error (measurement bias) are low. 2 The evaluation of BG systems should be performed in accordance with standard guidelines like the International Organization for Standardization (ISO) (ISO 15197:2013 In vitro diagnostic test systems-Requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus). Such guidelines describe in detail test procedures to be followed. They also specify the allowed measurement deviation of the measurement results from the laboratory measurements and the maximum number of inaccurate results or outliers acceptable. The analytical goals defined by the ISO guidelines are now widely adopted by manufacturers of BG systems and regulatory agencies.Despite the prerequisite of demonstrating compliance with ISO 15197 before market approval of a new BG system, the performance of currently available BG systems (= after market approval) has been fiercely debated after reports Abstract Background: The objective was to evaluate the performance (in terms of accuracy, precision, and trueness) of 5 CE-certified and commercially available blood glucose (BG) systems (meters plus test strips) using an innovative clinical-experimental study design with a 3-step glucose clamp approach and frequent capillary BG measurements. Methods:Sixteen subjects with type 1 diabetes participated in this open label, single center trial. BG was clamped at 3 levels for 60 minutes each: 60-100-200 mg/dL. Medical staff performed regular finger pricks (up to 10 per BG level) to obtain capillary blood samples for paired BG measurements with the 5 BG systems and a laboratory method as comparison. Conclusions: This 3 range glucose clamp approach enables a systematic performance evaluation of BG systems under controlled and reproducible conditions. The random error of the tested BG systems was comparable, but some showed a lower systematic error than others. These BG systems allow an accurate glucose measurement at low, normal and high BG levels. Results

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“…29 Perhaps this is not surprising as we learn about the impact of hypoglycemia on inflammatory activation. 30 This concern may even be more relevant for a patient with AMI because of the negative impact of hypoglycemia on ischemia 31 and arrhythmia.…”

Section: S-24 Hirsch and O'brienmentioning

confidence: 99%

How to Best Manage Glycemia and Non-Glycemia During the Time of Acute Myocardial Infarction

Hirsch

O’Brien

2012

Diabetes Technology & Therapeutics

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Acute myocardial infarction (AMI) is common in patients with diabetes. Reasons for this are multifactorial, but all relate to a variety of maladaptive responses to acute hyperglycemia. Persistent hyperglycemia is associated with worse left ventricular function and higher mortality during AMI, but intervention data are far from clear. Although there is a theoretical basis for the use of glucose-insulin-potassium infusion during AMI, lack of outcome efficacy (and inability to reach glycemic targets) in recent randomized trials has resulted in little enthusiasm for this strategy. Based on the increasing understanding of the dangers of hypoglycemia, while at the same time appreciating the role of hyperglycemia in AMI patients, goal glucose levels of 140-180 mg/dL using an intravenous insulin infusion while not eating seem reasonable for most patients and hospital systems. Non-glycemic therapy for patients with diabetes and AMI has benefited from more conclusive data, as this population has greater morbidity and mortality than those without diabetes. For ST-elevation myocardial infarction (STEMI), reperfusion therapy with primary percutaneous coronary intervention or fibrinolysis, antithrombotic therapy to prevent acute stent thrombosis following percutaneous coronary intervention or rethrombosis following thrombolysis, and initiation of b-blocker therapy are the current standard of care. Emergency coronary artery bypass graft surgery is reserved for the most critically ill. For those with non-STEMI, initial reperfusion therapy or fibrinolysis is not routinely indicated. Overall, there have been dramatic advances for the treatment of people with AMI and diabetes. The use of continuous glucose monitoring in this population may allow better ability to safely reach glycemic targets, which it is hoped will improve glycemic control.

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Effects of Acute Insulin-Induced Hypoglycemia on Indices of Inflammation

Cited by 178 publications

References 25 publications

Hypoglycaemia, thrombosis and vascular events in diabetes

Hypoglycaemia, thrombosis and vascular events in diabetes

A Comprehensive Performance Evaluation of Five Blood Glucose Systems in the Hypo-, Eu-, and Hyperglycemic Range

How to Best Manage Glycemia and Non-Glycemia During the Time of Acute Myocardial Infarction

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