Michael R. Rickels
Adults with long-standing type 1 diabetes may increase awareness of hypoglycemia and reduce severity of hypoglycemic events by using real-time continuous glucose monitoring, but the endogenous glucose counterregulation is only modestly improved, study data show.
“In long-standing type 1 diabetes, patients can develop reduced symptom awareness of hypoglycemia that can contribute to experiencing severe hypoglycemia episodes where assistance from another person is required and can result in seizures and coma,” Michael R. Rickels, MD, MS, associate professor of medicine in the division of endocrinology, diabetes and metabolism at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Endocrine Today. “This study was undertaken to determine if real-time knowledge of glucose levels, available continuously from a CGM, can specifically help the patients who are having the most problematic hypoglycemia to experience less low blood glucose and recover symptom awareness and physiologic defenses against the development of low blood glucose.”
Rickels and colleagues evaluated data on 11 adults with type 1 diabetes for more than 10 years (mean duration, 31 years; mean HbA1c, 7.2%; mean daily insulin requirement, 0.5 U/kg-1; 8 using insulin pump) and 12 adults without diabetes to determine whether real-time CGM can be used as a strategy for hypoglycemia avoidance and improved endogenous glucose counterregulation. Hypoglycemic and euglycemic clamps were used to measure the endogenous glucose production response before and 6 and 18 months after CGM initiation.
Hypoglycemia awareness (P < .01) and severity (P < .001) improved in participants with type 1 diabetes during the intervention period; a trend was also observed for a reduction in glycemic lability (P = .1).
During the hypoglycemic clamp, hyperinsulinemia was comparable in controls and participants with type 1 diabetes before and 6 and 18 months after implementation of real-time CGM.
Physiologic response in participants with diabetes did not change from before to 6 months after CGM initiation; however, endogenous glucose production improved by 18 months (P < .05 compared with pre-CGM measurement, but remained lower than among controls (P .01 for all comparisons.
“These findings are significant because in the absence of physiologic defenses against the development of low blood glucose, near-constant use of CGM may be required to minimize the burden of problematic hypoglycemia in patients with long-standing type 1 diabetes,” Rickels said. “Such patients would benefit from more consistent and universal health insurance coverage for this potentially lifesaving intervention.” – by Amber Cox
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Michael R. Rickels, MD, MS, can be reached at firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.