Incidence of severe hypoglycemia and its association with serum adiponectin in Japanese patients with type 1 and insulin‐treated type 2 diabetes: The Fukuoka Diabetes Registry

Abstract

Aims/Introduction The incidence of severe hypoglycemia and its risk factors including an insulin‐sensitizing adipokine, adiponectin, were prospectively investigated in Japanese patients with type 1 or insulin‐treated type 2 diabetes. Materials and Methods A total of 207 participants with type 1 diabetes (mean age 55 years) and 1,396 with insulin‐treated type 2 diabetes (mean age 65 years) from the local diabetes registry were followed for 5 years (follow‐up rate 99%). Severe hypoglycemia was defined as events requiring the assistance of others for recovery from hypoglycemia. Results The incidence of severe hypoglycemia was 9.2 per 100 person‐years in those with type 1 diabetes, and 2.3 per 100 person‐years in those with insulin‐treated type 2 diabetes, respectively. For type 1 diabetes, the risk was significant in those with a history of severe hypoglycemia within the previous year, slow eating and higher serum adiponectin (the highest vs the lowest in quartile hazard ratio 2.36, 95% confidence interval 1.22–4.69). For insulin‐treated type 2 diabetes, the risk included age ≥65 years, history of severe hypoglycemia within the previous year, alcohol consumption ≥60 g/day, larger insulin dose and higher serum adiponectin (the highest vs the lowest in quartile, hazard ratio 2.95, 95% confidence interval 1.22–4.69). For all participants, the incidence of severe hypoglycemia increased along with serum adiponectin (age‐ and sex‐adjusted hazard ratio 1.65 per 1 standard deviation increase of log serum adiponectin, 95% confidence interval 1.45–1.87). Conclusions The incidence of severe hypoglycemia was prospectively determined, and the association between severe hypoglycemia and higher serum adiponectin was observed in Japanese patients with type 1 and insulin‐treated type 2 diabetes.

Inverse association between glucose variability and body fat in type 2 diabetes with impaired endogenous insulin secretion assessed using continuous glucose monitoring: A prospective observational study

“…Adiponectin is an adipokine that increases insulin sensitivity 12 . A previous study based on data obtained via self‐administered questionnaires and a medical chart review showed that the development of severe hypoglycaemia is associated with a higher serum adiponectin concentration in people with type 1 diabetes and insulin‐treated type 2 diabetes 32 . However, in our study, serum adiponectin concentration had no effect on GV and hypoglycaemia in people with type 2 diabetes, regardless of their insulin secretion capacity.…”

“…12 A previous study based on data obtained via self-administered questionnaires and a medical chart review showed that the development of severe hypoglycaemia is associated with a higher serum adiponectin concentration in people with type 1 diabetes and insulin-treated type 2 diabetes. 32 However, in our study, serum adiponectin concentration had no effect on GV and hypoglycaemia in people with type 2 diabetes, regardless of their insulin secretion capacity. The reason for this discrepancy between studies may be that we used CGM to detect hypoglycaemia, including unconscious hypoglycaemia, to examine the association between GV and the serum adiponectin concentration.…”

Sudden Death Associated with Severe Hypoglycemia in a Diabetic Patient During Sensor-Augmented Pump Therapy with the Predictive Low Glucose Management System

“…Hypoglycemia is defined by the presence of a low plasma glucose level (<70 mg/dl in patients treated with insulin or insulin secretagogue), neurogenic and neuroglycopenic symptoms, and symptoms that ameliorate after carbohydrate administration. Patients with type 1 diabetes treated with hypoglycemic agents are at high risk of developing hypoglycemia [ 3 ]. Also, an increased incidence of hypoglycemia may contribute to increased mortality in diabetic patients [ 1 ].…”

“…Prevention of hypoglycemia is critical in the medical care of patients with diabetes mellitus treated with insulin [ 2 ]. In general, patients with type 1 diabetes mellitus under insulin therapy frequently develop insulinopenia that predisposes them to hypoglycemia [ 3 ]. Several studies have shown the benefit of continuous glucose monitoring sensors for reducing the incidence of hypoglycemia in patients at risk [ 4 – 6 ].…”

Novel Insight into the Mechanism of Metabolic Surgery Causing the Diversity in Glycemic Status in Type 2 Diabetes

“…Adiponectin gene variant (rs266729) has been reported to impact circulating adiponectin levels after metabolic surgery [68]. Higher serum adiponectin was found to be associated with severe hypoglycemia in a patient with T2D [104]. Moreover, one study found that GPL-1 induces over-proliferation of islet β-cells, triggering nesidioblastosis in adult gastric bypass patients [100].…”