Continuous Glucose Monitoring for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes
| العنوان: | Continuous Glucose Monitoring for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes |
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| المؤلفون: | Michael R. Rickels, Joseph Naji, Huong-Lan Nguyen, Sanjian Chen, Cornelia Dalton-Bakes, Amy J. Peleckis, Shannon O’Brien, Mark H. Schutta, Insup Lee, Nina A Ran |
| المصدر: | The Journal of Clinical Endocrinology & Metabolism. 103:105-114 |
| بيانات النشر: | The Endocrine Society, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, 030209 endocrinology & metabolism, Context (language use), macromolecular substances, Hypoglycemia, Biochemistry, Glucose production, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, medicine, In patient, 030212 general & internal medicine, Clinical Research Articles, Hypoglycemia unawareness, Type 1 diabetes, Continuous glucose monitoring, business.industry, Biochemistry (medical), nutritional and metabolic diseases, medicine.disease, Anesthesia, Hemoglobin, business |
| الوصف: | Context Patients with long-standing type 1 diabetes (T1D) are at increased risk for severe hypoglycemia because of defects in glucose counterregulation and recognition of hypoglycemia symptoms, in part mediated through exposure to hypoglycemia. Objective To determine whether implementation of real-time continuous glucose monitoring (CGM) as a strategy for hypoglycemia avoidance could improve glucose counterregulation in patients with long-standing T1D and hypoglycemia unawareness. Design, Setting, Participants, and Intervention Eleven patients with T1D disease duration of ∼31 years were studied longitudinally in the Clinical & Translational Research Center of the University of Pennsylvania before and 6 and 18 months after initiation of CGM and were compared with 12 nondiabetic control participants. Main Outcome Measure Endogenous glucose production response derived from paired hyperinsulinemic stepped-hypoglycemic and euglycemic clamps with infusion of 6,6-2H2-glucose. Results In patients with T1D, hypoglycemia awareness (Clarke score) and severity (HYPO score and severe events) improved (P < 0.01 for all) without change in hemoglobin A1c (baseline, 7.2% ± 0.2%). In response to insulin-induced hypoglycemia, endogenous glucose production did not change from before to 6 months (0.42 ± 0.08 vs 0.54 ± 0.07 mg·kg-1·min-1) but improved after 18 months (0.84 ± 0.15 mg·kg-1·min-1; P < 0.05 vs before CGM), albeit remaining less than in controls (1.39 ± 0.11 mg·kg-1·min-1; P ≤ 0.01 vs all). Conclusions Real-time CGM can improve awareness and reduce the burden of problematic hypoglycemia in patients with long-standing T1D, but with only modest improvement in the endogenous glucose production response that is required to prevent or correct low blood glucose. |
| تدمد: | 1945-7197 0021-972X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::64a8505ff88aa42482c9471f779758c7Test https://doi.org/10.1210/jc.2017-01516Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....64a8505ff88aa42482c9471f779758c7 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19457197 0021972X |
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