The consequences of hypoglycaemia

Amiel, Stephanie A.

doi:10.1007/s00125-020-05366-3

Cited by 95 publications

(76 citation statements)

References 61 publications

(65 reference statements)

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“…Symptoms of hypoglycemia are due to sympathetic activation (sweating, tremor, palpitations, anxiety) and to neuroglycopenia (hunger, slowing cognitive function, sleepiness, seizures, and coma). In people on insulin for long periods, all the responses are usually impaired, and recurrent exposure to hypoglycemia may result in lowering of the plasma glucose concentration, at which point stress responses are initiated, sometimes below the level at which cognitive deterioration starts, leading to impaired awareness of hypoglycemia [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions

Sala

Pontiroli

2021

IJMS

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The goal of diabetes care is to achieve and maintain good glycemic control over time, so as to prevent or delay the development of micro- and macrovascular complications in type 1 (T1D) and type 2 diabetes (T2D). However, numerous barriers hinder the achievement of this goal, first of all the frequent episodes of hypoglycemia typical in patients treated with insulin as T1D patients, or sulphonylureas as T2D patients. The prevention strategy and treatment of hypoglycemia are important for the well-being of patients with diabetes. Hypoglycemia is strongly associated with an increased risk of cardiovascular disease in diabetic patients, due probably to the release of inflammatory markers and prothrombotic effects triggered by hypoglycemia. Treatment of hypoglycemia is traditionally based on administration of carbohydrates or of glucagon via intramuscular (IM) or subcutaneous injection (SC). The injection of traditional glucagon is cumbersome, such that glucagon is an under-utilized drug. In 1983, it was shown for the first time that intranasal (IN) glucagon increases blood glucose levels in healthy volunteers, and in 1989-1992 that IN glucagon is similar to IM glucagon in resolving hypoglycemia in normal volunteers and in patients with diabetes, both adults and children. IN glucagon was developed in 2010 and continued in 2015; in 2019 IN glucagon obtained approval in the US, Canada, and Europe for severe hypoglycemia in children and adults. In the 2010s, two ready-to-use injectable formulations, a stable non-aqueous glucagon solution and the glucagon analog dasiglucagon, were developed, showing an efficacy similar to traditional glucagon, and approved in the US in 2020 and in 2021, respectively, for severe hypoglycemia in adults and in children. Fast-acting glucagon (nasal administration and injected solutions) appears to represent a major breakthrough in the treatment of severe hypoglycemia in insulin-treated patients with diabetes, both adults and children. It is anticipated that the availability of fast-acting glucagon will expand the use of glucagon, improve overall metabolic control, and prevent hypoglycemia-related complications, in particular cardiovascular complications and cognitive impairment.

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Section: Introductionmentioning

confidence: 99%

New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions

Sala

Pontiroli

2021

IJMS

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“…Importantly, SH is a cumulative consequence of antecedent hypoglycaemic events in high-risk patients who have attenuated defence mechanisms for hypoglycaemia [72]. Therefore, clinical guidelines recommend that the occurrence and risk of hypoglycaemia in patients with diabetes should be evaluated at every visit to a medical facility [73].…”

Section: Hypoglycaemia and Cvdmentioning

confidence: 99%

Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes

Yun

2021

Metabolism

128

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With the advances in diabetes care, the trend of incident cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) has been decreasing over past decades. However, given that CVD is still a major cause of death in patients with diabetes and that the risk of CVD in patients with T2DM is more than twice that in those without DM, there are still considerable challenges to the prevention of CVD in diabetes. Accordingly, there have been several research efforts to decrease cardiovascular (CV) risk in T2DM. Large-scale genome-wide association studies (GWAS) and clinical cohort studies have investigated the effects of factors, such as genetic determinants, hypoglycaemia, and insulin resistance, on CVD and can account for the unexplained CV risk in T2DM. Lifestyle modification is a widely accepted cornerstone method to prevent CVD as the first-line strategy in T2DM. Recent reports from large CV outcome trials have proven the positive CV effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with high CVD risk. Overall, current practice guidelines for the management of CVD in T2DM are moving from a glucocentric strategy to a more individualised patient-centred approach. This review will discuss the current epidemiologic trends of CVD in T2DM and the risk factors linking T2DM to CVD, including genetic contribution, hypoglycaemia, and insulin resistance, and proper care strategies, including lifestyle and therapeutic approaches.

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“…The use of newer rapid-acting analogues and long-acting basal insulins, together with continuous glucose monitoring, has reduced the rates of hypoglycaemia in many people with type 1 diabetes. However, despite these important advances, the consequences of hypoglycaemia remain burdensome and represent a substantial challenge and barrier to intensification of glycaemic control in many people with type 1 diabetes [10]. A great deal of progress has been made in understanding the mechanisms of glucose sensing in the brain and peripheral tissues, identifying how multiple defects in these physiological mechanisms contribute to hypoglycaemia susceptibility in people with type 1 diabetes.…”

Section: Hypoglycaemiamentioning

confidence: 99%

“…Important questions surround the optimal dosing regimens and duration of immunosuppressive therapy required to produce the meaningful clinical benefit theoretically associated with the preservation of C-peptide. These benefits might include reduced rates of ketoacidosis, lower HbA 1c , greater time in range, lower rates of hypoglycaemia and, ideally, reduced rates of complications beyond those achievable with conventional intensification of insulin therapy [10]. It seems likely that combinations of immunosuppressive agents would produce even greater preservation of beta cell function than one therapy alone; however, understanding the long-term safety of such approaches is not trivial.…”

Section: Prevention Of Type 1 Diabetes and Preservation Of Beta Cell mentioning

confidence: 99%

Transforming type 1 diabetes: the next wave of innovation

Drucker

2021

Diabetologia

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The discovery of insulin in 1921 enabled pharmaceutical production of animal insulins for the treatment of people with type 1 diabetes by 1922. The last several decades have witnessed enormous scientific progress in the therapy of type 1 diabetes, yet some developments have been incremental, and insulin is not a cure. Herein, I highlight key scientific advances potentially poised to improve the quality of life and treatment outcomes in type 1 diabetes. These innovations range from newer insulin analogues to the development of smart insulins, oral and weekly insulins, glucose sensors and closed-loop insulin-delivery devices, as well as strategies for durable human beta cell replacement coupled with selective immune manipulation to preserve beta cell function. Finally, progress in the prediction and prevention of type 1 diabetes highlights the ongoing challenges and potential for altering the natural history of the disease or eliminating type 1 diabetes altogether.

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The consequences of hypoglycaemia

Cited by 95 publications

References 61 publications

New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions

New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions

Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes

Transforming type 1 diabetes: the next wave of innovation

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