Non‐severe hypoglycaemia is associated with weight gain in patients with type 1 diabetes: Results from the Diabetes Control and Complication Trial

Bumbu, Anisoara; Moutairou, Abdul; Matar, Odette; Fumeron, Frédéric; Riveline, Jean‐Pierre; Gautier, Jean‐François; Marre, Michel; Roussel, Ronan; Potier, Louis

doi:10.1111/dom.13197

Cited by 17 publications

(21 citation statements)

References 15 publications

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“…The increase in food intake, associated with hypoglycemia treatment, can also have consequences on body weight. Recent data from DCCT study [30] have shown a significant association between non-severe hypoglycemia frequency and weight gain. In our study, we found 2.7 episodes of hypoglycemia a week, treated on average with 144.6 kcal.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

et al. 2020

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Introduction: Hypoglycemia is the most common acute complication in individuals with type 1 diabetes (T1D). Episodes of mild or moderate hypoglycemia should be treated in adults with a dose of around 15–20 g fast-acting carbohydrates. However, this self-treatment of hypoglycemia in real-life condition is not well documented. Objective: The aim of this study wasto determine the characteristics of hypoglycemia treatment in adults with T1D in a prospective study design. Methods: Individuals with T1D were advised to record information related to hypoglycemia episodes for a period of 14 days. Quantity and quality (including glycemic index [GI] and glycemic load) of carbohydrates consumed in every hypoglycemia episode and others factors related with hypoglycemia such as physical activity, fear of hypoglycemia, or hypoglycemia awareness were analyzed. Results: A total of 93 individuals (36.5 ± 16.2 years old, BMI of 24.9 ± 3.8 kg/m2, diabetes duration of 14.9 ± 10.4 years, and HbA1c levels of 7.3 ± 0.8%) were included in the study. A total of 483 episodes of mild or moderate hypoglycemia were reported, which supposed on average 2.7 ± 2.0 episodes a week. The quantity of carbohydrates consumed in all episodes of hypoglycemia was 25.9 ± 9.2 g. GI of food consumed in all episodes of hypoglycemia was classified as low (53.9 ± 8.3). Overtreatment of hypoglycemia, defined as ingestion of more than 20 g of carbohydrates, occurred in 50.3% of hypoglycemic episodes; even 22.3% of these episodes were treated with more than 30 g of carbohydrates. Fruit juice was the most popular option, chosen in almost 70% of the events. In addition, we observed other moderate or low GI foods such as milk, bread, cookies, and bakery products among the most consumed foods. Conclusion: A majority of the studied individuals with T1D does not manage hypoglycemia according to current American Diabetes Association guidelines, in most cases by overtreating, choosing foods with low glycemic effect, and not varying the dose of carbohydrates, depending on the physical activity performed.

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Section: Discussion/conclusionmentioning

confidence: 99%

Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

et al. 2020

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“…However, hypoglycemia, which still occurs daily in the majority of individuals with T1D, demands swift treatment with sugar-rich beverages such as soft drinks and/or ingestion of industrially processed food, often rich in fructose. As a consequence, weight gain due to hypoglycemia-induced defensive snacking is an important factor contributing to overweight or obesity ( Bumbu et al, 2018 ). Therefore, in individuals with T1D, especially when insulin therapy is not optimally tailored, weight gain due to energy- and fructose-rich defensive snacking could be a specific additional pathway leading to NAFLD susceptibility.…”

Section: Methodsmentioning

confidence: 99%

Hepatopathy Associated With Type 1 Diabetes: Distinguishing Non-alcoholic Fatty Liver Disease From Glycogenic Hepatopathy

et al. 2021

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Autoimmune destruction of pancreatic β-cells results in the permanent loss of insulin production in type 1 diabetes (T1D). The daily necessity to inject exogenous insulin to treat hyperglycemia leads to a relative portal vein insulin deficiency and potentiates hypoglycemia which can induce weight gain, while daily fluctuations of blood sugar levels affect the hepatic glycogen storage and overall metabolic control. These, among others, fundamental characteristics of T1D are associated with the development of two distinct, but in part clinically similar hepatopathies, namely non-alcoholic fatty liver disease (NAFLD) and glycogen hepatopathy (GlyH). Recent studies suggest that NAFLD may be increasingly common in T1D because more people with T1D present with overweight and/or obesity, linked to the metabolic syndrome. GlyH is a rare but underdiagnosed complication hallmarked by extremely brittle metabolic control in, often young, individuals with T1D. Both hepatopathies share clinical similarities, troubling both diagnosis and differentiation. Since NAFLD is increasingly associated with cardiovascular and chronic kidney disease, whereas GlyH is considered self-limiting, awareness and differentiation between both condition is important in clinical care. The exact pathogenesis of both hepatopathies remains obscure, hence licensed pharmaceutical therapy is lacking and general awareness amongst physicians is low. This article aims to review the factors potentially contributing to fatty liver disease or glycogen storage disruption in T1D. It ends with a proposal for clinicians to approach patients with T1D and potential hepatopathy.

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“…A proposed differential mechanism of liver damage in T1DM relates to the increase in visceral adiposity secondary to frequent snacking in the hypoglycemia context, which increases caloric and fructose intake [ 111 ]. Other mechanisms that may explain the development of hepatic complications in patients with T1DM are the relative portal vein insulin deficiency that leads to altered hepatic glycogen storage, absence of inhibition of hepatic gluconeogenesis, and overall metabolic disturbance with a shunt to lipogenic pathways [ 14 , 112 , 113 ].…”

Section: Diabetes Clinical Phenotypesmentioning

confidence: 99%

When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD

Rojano-Toimil

Rivera‐Esteban

Manzano-Núñez

et al. 2022

JCM

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Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug therapies.

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Non‐severe hypoglycaemia is associated with weight gain in patients with type 1 diabetes: Results from the Diabetes Control and Complication Trial

Cited by 17 publications

References 15 publications

Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

Hepatopathy Associated With Type 1 Diabetes: Distinguishing Non-alcoholic Fatty Liver Disease From Glycogenic Hepatopathy

When Sugar Reaches the Liver: Phenotypes of Patients with Diabetes and NAFLD

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