Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

Nakhleh, Afif; Shehadeh, Naim

doi:10.4239/wjd.v12.i12.2036

Cited by 48 publications

(37 citation statements)

References 69 publications

(62 reference statements)

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“…The existing researches regards hypoglycemic fear as a whole and studies the relationship between it and other variables (Nakhleh & Shehadeh, 2021;Przezak, Bielka, & Molęda, 2022) which will lead to spurious correlations among variables easily appear when there are more variables. We do not know how the items in the two dimensions of hypoglycemic fear, hypoglycemic worries and hypoglycemic avoidance, interact with each other.…”

Section: Introductionmentioning

confidence: 99%

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

Wang

Cheng

et al. 2022

Preprint

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Background: The fear of hypoglycemia in type 2 diabetes mellitus (T2DM) patients with hypoglycemia has seriously affected their quality of life. They are always afraid of hypoglycemia and often take excessive action to avoid it. Yet, researchers have investigated the relationship between hypoglycemia worries and excessive avoiding hypoglycemia behavior using total scores on self-report measures. However, network analysis studies of hypoglycemia worries and excessive avoiding hypoglycemia behavior in T2DM patients with hypoglycemia are lacking. Purpose: The present study investigated the network structure of hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia and aimed to identify bridge items to help them correctly treat hypoglycemia and properly deal with hypoglycemia fear. Methods: A total of 283 T2DM patients with hypoglycemia were enrolled in our study. Hypoglycemia worries and avoiding hypoglycemia behavior were evaluated with the Hypoglycemia Fear Scale. Network analyses were used for the statistical analysis. Results: B9 “Had to stay at home for fear of hypoglycemia” and W12 “I am worried that hypoglycemia will affect my judgment” have the highest expected influences in the present network. In the community of hypoglycemia worries, W17 “I worry about hypoglycemia during sleep” has the highest bridge expected influence. And in the community of avoiding hypoglycemia behavior, B9 has the highest bridge expected influence. Conclusion: Complex patterns of associations existed in the relationship between hypoglycemia worries and avoiding hypoglycemia behavior in T2DM patients with hypoglycemia. From the perspective of network analysis, W17 “I worry about hypoglycemia during sleep” aspect of hypoglycemia worries and B9 “Had to stay at home for fear of hypoglycemia” aspect of avoiding hypoglycemia behavior may be the main targets for reducing the fear of hypoglycemia. These results have important implications for clinical practice, which provided potential targets for interventions to reduce hypoglycemia fear and improve the quality of life in T2DM patients with hypoglycemia.

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Section: Introductionmentioning

confidence: 99%

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

Wang

Cheng

et al. 2022

Preprint

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show abstract

“…Hypoglycemia, defined as the SMBG levels < 70 mg/dL or when patients suffered from hypoglycemia symptoms, such as weakness, sweating, fast pulse, pallor, dizziness, headache, or loss of consciousness 13 (see also the Clinical Trial Protocol which can be accessed on the website: https://clinicaltrials.gov/ct2/show/NCT03102424 ), was the most frequent AE reported, occurring in five (6%) patients in the TENS group vs. nine (11%) patients in the placebo group. Of 100 AEs reported in total, 20 hypoglycemia events were reported by 14 subjects, including 14 events by nine subjects in placebo group (30%) and six events by five subjects in the TENS group (11%).…”

Section: Resultsmentioning

confidence: 99%

A randomized trial on the effect of transcutaneous electrical nerve stimulator on glycemic control in patients with type 2 diabetes

Lü

et al. 2023

Sci Rep

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Transcutaneous electrical nerve stimulator (TENS) has been demonstrated to be beneficial in glycemic control in animal models, but its application in humans has not been well studied. We randomly assigned 160 patients with type 2 diabetes on oral antidiabetic drugs 1:1 to the TENS study device (n = 81) and placebo (n = 79). 147 (92%) randomized participants (mean [SD] age 59 [10] years, 92 men [58%], mean [SD] baseline HbA1c level 8.1% [0.6%]) completed the trial. At week 20, HbA1c decreased from 8.1% to 7.9% in the TENS group (− 0.2% [95% CI − 0.4% to − 0.1%]) and from 8.1% to 7.8% in the placebo group (− 0.3% [95% CI − 0.5% to − 0.2%]) (P = 0.821). Glycemic variability, measured as mean amplitude of glycemic excursion (MAGE) at week 20 were significantly different in the TENS group vs. the placebo group (66 mg/dL [95% CI 58, 73] vs. 79 mg/dL [95% CI 72, 87]) (P = 0.009). Our study provides the clinical evidence for the first time in humans that TENS does not demonstrate a statistically significant HbA1c reduction. However, it is a safe complementary therapy to improve MAGE in patients with type 2 diabetes.

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“…From Table 5 , RA patients were prescribed with significantly fewer accumulative days of biguanides when compared with non-RA patients within the first year of RA with an adjusted odds ratio of 0.72 and 95% CI 0.53–0.99. As for sulfonylureas, RA patients were continuously prescribed with less sulfonylurea in the 1-, 2-, and 3-year analysis (Table 5 ), which may be related to its low priority of treatment recommendation and its risk of hypoglycemia events ( 33 ). Although sulfonylureas were less frequently prescribed, we were still able to appreciate its low cumulative incidence rate of RA in Figure 2 .…”

Section: Discussionmentioning

confidence: 99%

Sulfonylureas or biguanides is associated with a lower risk of rheumatoid arthritis in patients with diabetes: A nationwide cohort study

Huang

Chu

et al. 2022

Front. Med.

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ObjectiveDiabetes mellitus (DM) is associated with immune dysregulation, while sulfonylureas or biguanides have been linked to anti-inflammatory mechanisms. In this study, we aimed to examine the occurrence rate of rheumatoid arthritis (RA) among DM patients and its incidence rate between different treatments.MethodsThis cohort study used the Taiwan National Health Insurance Research Database between 1997 and 2013 to evaluate the primary outcomes of the preventive role of sulfonylureas or biguanides in the development of RA. We used the Chi-square test for categorical variables and Cox proportional hazard regression and log-rank test to explore the time for development of RA in DM patients. Logistic regression was adopted to estimate the odds ratio of RA in different dosages of medication exposure.ResultsOur cohort study included 94,141 DM cases. The risk of RA development of non-sulfonylureas/biguanides users among the DM group in each analysis was set as the reference, and the adjusted hazard ratio of RA in DM patients who were using sulfonylureas or biguanides was 0.73 (95% confidence interval 0.60–0.90). Within 1 year before the index date, compared with no-biguanides users, patients with more than 180 days of prescription of biguanides had a significantly lower RA risk. Similarly, the significantly lower risk of RA was still observed in DM patients who had more than 365 days of prescription of sulfonylurea within 2 or 3 years before the index date of first RA visit (all p < 0.05).ConclusionOur data suggest that sulfonylureas or biguanides are associated with a lower rate of RA development in patients with DM; the effect of biguanides appeared more rapid than that of sulfonylureas, but the sulfonylureas might have a longer effect on lowering RA development incidence.

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Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention

Cited by 48 publications

References 69 publications

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis

A randomized trial on the effect of transcutaneous electrical nerve stimulator on glycemic control in patients with type 2 diabetes

Sulfonylureas or biguanides is associated with a lower risk of rheumatoid arthritis in patients with diabetes: A nationwide cohort study

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