Association between recent exposure to continuous glucose monitoringārecorded hypoglycaemia and counterregulatory and symptom responses to subsequent controlled hypoglycaemia in people with type 1 diabetes
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jats:titleAbstract</jats:title>jats:secjats:titleAim</jats:title>jats:pExperimental hypoglycaemia blunts the counterregulatory hormone and symptom responses to a subsequent episode of hypoglycaemia. In this study, we aimed to assess the associations between antecedent exposure and continuous glucose monitoring (CGM)ārecorded hypoglycaemia during a 1āweek period and the counterregulatory responses to subsequent experimental hypoglycaemia in people with type 1 diabetes.</jats:p></jats:sec>jats:secjats:titleMaterials and Methods</jats:title>jats:pFortyātwo people with type 1 diabetes (20 females, meanāĀ±āSD glycated haemoglobin 7.8%āĀ±ā1.0%, diabetes duration median (interquartile range) 22.0 (10.5ā34.9) years, 29 CGM users, and 19 with impaired awareness of hypoglycaemia) wore an open intermittently scanned CGM for 1 week to detect hypoglycaemic exposure before a standardized hyperinsulinaemicāhypoglycaemic [2.8āĀ±ā0.1āmmol/L (50.2āĀ±ā2.3āmg/dl)] glucose clamp. Symptom responses and counterregulatory hormones were measured during the clamp. The study is part of the HypoRESOLVE project.</jats:p></jats:sec>jats:secjats:titleResults</jats:title>jats:pCGMārecorded hypoglycaemia in the week before the clamp was negatively associated with adrenaline response [Ī² ā0.09, 95% CI (ā0.16, ā0.02) nmol/L, jats:italicp</jats:italic>ā=ā.014], after adjusting for CGM use, awareness of hypoglycaemia, glycated haemoglobin and total daily insulin dose. This was driven by level 2 hypoglycaemia [<3.0āmmol/L (54āmg/dl)] [Ī² ā0.21, 95% CI (ā0.41, ā0.01) nmol/L, jats:italicp</jats:italic>ā=ā.034]. CGMārecorded hypoglycaemia was negatively associated with total, autonomic, and neuroglycopenic symptom responses, but these associations were lost after adjusting for potential confounders.</jats:p></jats:sec>jats:secjats:titleConclusions</jats:title>jats:pRecent exposure to CGMādetected hypoglycaemia was independently associated with an attenuated adrenaline response to experimental hypoglycaemia in people with type 1 diabetes.</jats:p></jats:sec>
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Publication status: Published
Funder: International Diabetes Federation; doi: http://dx.doi.org/10.13039/100019619
Funder: Innovative Medicines Initiative Joint Undertaking
Funder: the Juvenile Diabetes Research Foundation (JDRF)
Funder: Horizon 2020 Framework Programme; doi: http://dx.doi.org/10.13039/100010661
Funder: HCT; doi: http://dx.doi.org/10.13039/100012812
Funder: European Federation of Pharmaceutical Industries and Associations; doi: http://dx.doi.org/10.13039/100013322
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1463-1326