Silent Hypoglycemia in Patients with Diabetes

Open access

Abstract

Introduction. Iatrogenic hypoglycemia increases cardiovascular morbidity sometimes even with fatalities, and also increases cognitive disorders in most people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Hypoglycemia is characterized by unawareness if the sympathoadrenal response is attenuated during the night, in autonomic neuropathy or in elderly patients. Therefore, hypoglycemia is a limiting factor in the glycemic management of diabetes.

Methods. We aimed to analyze the hypoglycemic events and the time spent with low glucose level (glucose <3.9 mmol/l) in patients with diabetes (T1D, T2D) with insulin therapy (basal or basal-bolus), in ambulatory or hospital setting. The glucose variability was assessed via the interstitial glucose concentration, measured with a Continuous Glucose Monitoring (CGM) system over 72 hours.

Results. The incidence, severity and duration of hypoglycemia are not correlated with HbA1c, disease’s duration and patient’s age. In patients with T1D, severe hypoglycemia is more frequent in patients with a long duration of diabetes. In this analysis, the type of basal analog insulin did not influence the presence of hypoglycemia (p=0.7), but the duration of nocturnal hypoglycemia was longer with insulin glargine U100 than with insulin detemir. The basal regimen is more protective for hypoglycemia than basal-bolus insulin.

Conclusions. The study suggested that hypoglycemic events are common, silent and prolonged in 1/3 of patients with T1D and T2D. The CGM system is beneficial for all patients with T1D and for patients with T2D with hypoglycemic risk and complications, to adjust medication in order to prevent cardiovascular events.

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  • 1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:8378533

  • 2. Busko M.- VADT at 10 years - Tight glucose control cuts cardiovascular events.Medscape June 2015

  • 3. Cyrus V. Desouza Geremia B. Bolli and Vivian Fonseca - Hypoglycemia Diabetes and Cardiovascular Events in Diabetes Care. 2010 Jun; 33(6): 13891394.

  • 4. Heller SR. Abnormalities of the electrocardiogram during hypoglycaemia: the cause of the dead in bed syndrome? In International Journal of Clinical Practice Suppl. 2002- Jul;(129):27-32.

  • 5. Richard M. Plotzker - Hypoglycemia 25 Years After DCCT -Medscape - Jun 27 2018. p1.

  • 6. Seaquist ER Anderson J Childs B et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.Diabetes Care2013;36:13841395)

  • 7. Samson WK Stein LM Elrick M et al. - Hypoglycemia unawareness prevention: Targeting glucagon production. PhysiolBehav. 2016 Aug 1;162:147-50. doi: 10.1016/j.physbeh.2016.04.012.

  • 8. Silva TP Rolim LC SallumFilho C. et al - Association between severity of hypoglycemia and loss of heart rate variability in patients with type 1 diabetes mellitus. Diabetes Metab Res Rev. 2016 May 30. doi: 10.1002/dmrr.2830.

  • 9. Jennum P Stender-Petersen K Rabøl R Jørgensen NR Chu PL Madsbad S. - The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes Diabetes Care. 2015 Nov;38(11):2151-7. doi: 10.2337/dc15-0907. Epub 2015 Sep 25

  • 10. Frier BM Schernthaner G Heller S - Hypoglycemia and cardiovascular risks. Diabetes Care2011;34(Suppl. 2):S132S137pmid:21525444

  • 11. Torimoto K Okada Y Mori H Tanaka Y. Relationship between fluctuations in glucose levels measured by continuous glucosemonitoring and vascular endothelial dysfunction in type 2 diabetes mellitus. Cardiovascular Diabetology. 2013;12(article 1) (PMC free article) (PubMed)

  • 12. Gong Su Shuhua Mi Hong Tao Zhao Li Hongxia Yang Hong Zheng Yun Zhou and Changsheng M - Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes in Cardiovascular Diabetology 201110:19DOI: 10.1186/1475-2840-10-19

  • 13. Xingguang Zhang Xiuping Xu Xiumin Jiao Jinxiao Wu Shujing Zhou and Xiaofeng Lv - The Effects of Glucose Fluctuation on the Severity of Coronary Artery Disease in Type 2 Diabetes Mellitus in J Diabetes Res. 2013; 2013: 576916. Published online Jul 7 2013. doi: 10.1155/2013/576916 PMCID: PMC3723244).

  • 14. Eberhard Standl MD Oliver Schnell MD and Antonio Ceriello MD - Postprandial Hyperglycemia and Glycemic Variability - Should we care? In Diabetes Care. 2011 May; 34(Suppl 2): S120S127. Published online 2011 Apr 22. doi: 10.2337/dc11-s206PMCID: PMC3632148

  • 15. Xingran Cui Amir Abduljalil Brad D. Manor Chung- Kang Peng Vera Novak - Multi-Scale Glycemic Variability: A Link to Gray Matter Atrophy and Cognitive Decline in Type 2 DiabetesPublished: January 24 2014 http://dx.doi.org/10.1371/journal.pone.0086284

  • 16. Engler B Koehler C Hoffmann C et al. - Relationship between HbA1c on target risk of silent hypoglycemia and glycemic variability in patients with type 2 diabetes mellitus in Exp Clin Endocrinol Diabetes. 2011 Jan;119(1):59-61. doi: 10.1055/s-0030-1262874. Epub 2011 Jan 18

  • 17. Kilpatrick ES Rigby AS Goode K Atkin SL. - Relating mean blood glucose and glucose variability to the risk of multiple episodes of hypoglycaemia in type 1 diabetes. Diabetologia. 2007;50:255361. (PubMed)

  • 18. Hoffman RP Dye AS Huang H Bauer JA - Glycemic variability predicts inflammation in adolescents with type 1 diabetes in J Pediatr Endocrinol Metab. 2016 Oct 1;29(10):1129-1133. doi: 10.1515/jpem-2016-0139

  • 19. Brod M Christensen T Thomsen TL Bushnell DM. - The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health 2011; 14: 665-71

  • 20. Feig DS Asztalos E Corcoy R De Leiva A et al- CONCEPTT Collaborative Group. CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial: A multi-center multi-national randomized controlled trial - Study protocol. In BMC Pregnancy Childbirth. 2016 Jul 18;16(1):167. doi: 10.1186/s12884-016-0961-5.

  • 21. Rebrin K Steil GM.-Can interstitial glucose assessment replaces blood glucose measurement? Diabetes Technol Ther 2000;2:461-72

  • 22. Heller S1 Bode B Kozlovski P Svendsen AL- Meta- analysis of insulin aspart versus regular human insulin used in a basal-bolus regimen for the treatment of diabetes mellitus.in Journal Diabetes. 2013 Dec;5(4):482-91. doi: 10.1111/1753-0407.12060. Epub 2013 May 7.

  • 23. Toschi E Wolpert H. - Utility of Continuous Glucose Monitoring in Type 1 and Type 2 Diabetes in Endocrinol Metab Clin North Am. 2016 Dec;45(4):895-904. doi: 10.1016/j.ecl.2016.06.003. Epub 2016 Sep 28.

  • 24. Alfadhli E Osman E Basri T - Use of a real time continuous glucose monitoring system as an educational tool for patients with gestational diabetes. In Diabetol Metab Syndr. 2016 Jul 26;8:48. doi: 10.1186/s13098-016-0161-5. eCollection 2016

  • 25. Poantă L Porojan M Clus S Dumitraşcu DL - Cardiovascular autonomic neuropathy in diabetes mellitus..RomJ Intern Med. 2009;47(4):403-7.

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