Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

Abstract

Aims/hypothesis Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness. Methods Twenty-four patients with type 1 diabetes (ten aware, 14 unaware) were studied during normoglycaemia (5.0-6.0 mmol/l), hypoglycaemia (2.0-2.5 mmol/l) and during recovery from hypoglycaemia (5.0-6.0 mmol/l) using hyperinsulinaemic glucose clamping. During each 1 h phase, Ts was measured twice by infrared thermography imaging in pre-defined areas (nose, glabella and the five left fingertips), symptoms of hypoglycaemia were scored and blood was sampled.Results Ts decreased during hypoglycaemia on the nose and glabella. The highest decrements were recorded on the nose (aware: −2.6°C, unaware: −1.1°C). In aware patients, the differences in temperature were statistically significant on both nose and glabella, whereas there was only a trend in the unaware group. There was a significant difference in hypoglycaemia-induced temperature changes between the groups. Patients in the aware group had higher hypoglycaemia symptom scores and higher adrenaline (epinephrine) levels during hypoglycaemia. Conclusions/interpretation The hypoglycaemia-associated decrement in Ts can be assessed by infrared thermography Diabetologia (2015) 58:1898-1906 DOI 10.1007 Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3616-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. and is larger in patients with normal hypoglycaemia awareness compared with unaware patients.

Evaluation of Hypoglycaemia with Non-Invasive Sensors in People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia

“…Sejling et al . found that there is a decrement in skin temperature during hypoglycaemia, and that this decrement is less in IAH patients 20 . Circumstances that could affect a participant’s temperature include the hand/arm-warmer, placement of the sensor and the ambient temperature in the room.…”

“…Sejling et al . 19 , 20 have previously investigated people with IAH during hypoglycaemic clamp, and compared their responses with people with normal hypoglycaemia awareness. Sweating and ECG-changes were not assessed.…”

Non-invasive prediction of blood glucose trends during hypoglycemia

“…Another explanation could be that the shoulder is just not a good place to measure temperature differences. Sejling et al found that the nose experienced the largest temperature fall (178), although hardly a good place for a temperature sensor. It may be that larger variations exist during sleep, and provide even more information for an alarm algorithm, which potentially can be explored later.…”

Quantitative evaluation of skin disorders in type 1 diabetic mice by in vivo optical imaging

“…Diabetes not only leads to changes in skin structure, but also in skin components, such as variation of epidermal and dermal features [2], as well as nerve fiber loss [1,6]. Some studies show that diabetes induces skin dysfunctions like reduced skin barrier functions [7], changes in mechanical properties of dermal collagen fibril [8], mechanical hyposensitivity and abnormal temperature of skin [9,10]. In addition, the abnormal changes in motor behavior of skin immune cells or skin microvascular function occur with the development of diabetes [11,12].…”