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Association between recent exposure to continuous glucose monitoringā€recorded hypoglycaemia and counterregulatory and symptom responses to subsequent controlled hypoglycaemia in people with type 1 diabetes

Published version
Peer-reviewed

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Abstract

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)ā€recorded hypoglycaemia during a 1ā€week 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:pFortyā€two people with type 1 diabetes (20 females, meanā€‰Ā±ā€‰SD glycated haemoglobin 7.8%ā€‰Ā±ā€‰1.0%, diabetes duration median (interquartile range) 22.0 (10.5ā€34.9) 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 hyperinsulinaemicā€hypoglycaemic [2.8ā€‰Ā±ā€‰0.1ā€‰mmol/L (50.2ā€‰Ā±ā€‰2.3ā€‰mg/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:pCGMā€recorded hypoglycaemia in the week before the clamp was negatively associated with adrenaline response [Ī² āˆ’0.09, 95% CI (āˆ’0.16, āˆ’0.02) 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 [<3.0ā€‰mmol/L (54ā€‰mg/dl)] [Ī² āˆ’0.21, 95% CI (āˆ’0.41, āˆ’0.01) nmol/L, jats:italicp</jats:italic>ā€‰=ā€‰.034]. CGMā€recorded 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 CGMā€detected hypoglycaemia was independently associated with an attenuated adrenaline response to experimental hypoglycaemia in people with type 1 diabetes.</jats:p></jats:sec>

Description

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

Keywords

diabetes, continuous glucose monitoring, counterregulatory hormone and symptom responses, counterregulation, type 1 diabetes, hypoglycaemia awareness, hyperinsulinaemicā€hypoglycaemic clamp, hypoglycaemia

Journal Title

Diabetes, Obesity and Metabolism

Conference Name

Journal ISSN

1462-8902
1463-1326

Volume Title

Publisher

Wiley