Medical therapy in patients with endogenous hypoglycaemia: Is euglycaemia achievable?

Abstract

Summary Context While the only curative treatment for patients with endogenous hypoglycaemia related to inappropriate insulin or to insulin growth factor 2 (IGF2) secretion is surgery, medical treatment to normalize plasma glucose levels can be useful. Objective The aim of this prospective single centre study was to assess whether patients with endogenous hypoglycaemia, considered euglycaemic with medical treatments, experienced asymptomatic hypo‐ or hyperglycaemic excursions. Patients and Methods All patients with endogenous hypoglycaemia related to inappropriate insulin or to IGF2 secretion between 2012 and 2016 and considered normoglycaemic with medical treatment (absence of clinical hypoglycaemia and self‐monitoring blood glucose in the normal range) were enroled and underwent a six‐day continuous glucose monitoring (CGM) recording. Results Twenty‐seven patients (inappropriate insulin secretion n = 25 and IGF2 secretion n = 2), treated with diazoxide (n = 16), somatostatin analogues (n = 7), glucocorticoids (n = 3) or a combination of these treatments (n = 1) were enroled. Twenty‐five CGMs were analysed. CGM confirmed normoglycaemia in 11/25 patients (44%). Hypoglycaemias below 0.60 g/L were present in seven patients (28%) and were associated with hyperglycaemic excursions above 1.40 g/L in five patients. Seven patients (28%) had only hyperglycaemic excursions. Based on these results, treatment was modified in 14 patients (56%). Conclusion Despite the disappearance of hypoglycaemia‐related clinical symptoms and normalization of blood glucose self‐monitoring data, 56% of the patients with endogenous hypoglycaemia treated with medical therapy experienced asymptomatic hypo‐ and/or hyperglycaemia. Continuous glucose monitoring could be a useful approach to reveal and prevent hypo‐ or hyperglycaemic excursions.

Lanreotide and diazoxide have comparable effects on glucose levels in an elderly Japanese insulinoma patient: a case report

“…Vezzosi et al recently reported that CGM can diagnose hyper- and hypo-glycemia unawareness in patients with a drug-treated insulinoma 13 ) . In this study, lanreotide and diazoxide had comparable effects on interstitial glucose levels in CGM.…”

Continuous glucose monitoring for hypoglycaemia in children: Perspectives in 2020

“…In adult patients with HH, 28% of those studied had asymptomatic hypoglycaemia detected by CGM and required subsequent treatment alterations 59 . In adult patients with hypoglycaemia secondary to insulinoma, CGM also identified significant hypoglycaemia in patients who were thought to be normoglycaemic.…”