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Real life evidence that impaired awareness of hypoglycemia persists for years in patients with type 1 diabetes.

ABSTRACT: AIMS:To determine if impaired awareness of hypoglycemia in patients with type 1 diabetes persists over time and to assess if continuous glucose monitoring use was associated with improved awareness of hypoglycemia in our population. METHODS:Thirty-six with type 1 diabetes and impaired awareness of hypoglycemia who participated in studies on impaired awareness of hypoglycemia between 2009 and 2015 were contacted to complete an online survey. The survey included the Cox/Clarke and Gold hypoglycemia questionnaires and questions about continuous glucose monitoring use. RESULTS:23 of 36 (63%) subjects contacted completed the survey. (12?M, 11?F; median age 51?years, median diabetes duration 34?years). One had had an islet cell transplant and was excluded. Persistent impaired awareness of hypoglycemia was found in 19/22 (86%) using the Cox questionnaire and 18/22 (82%) using the Gold questionnaire. Consistent use of continuous glucose monitoring over the last six months defined as using a device ?75% of time over the last 6?months was reported by 67% (12/18) and 68% (13/19) of participants with persistent impaired awareness of hypoglycemia as measured by Gold and Cox; respectively. Nineteen of the 22 participants (86%) reported severe hypoglycemia over the last six months. CONCLUSION:Impaired awareness of hypoglycemia persisted in >80% of the subjects with type 1 diabetes we studied between 2009 and 2015. While the consistent use of continuous glucose monitoring among our participants was high; it did not translate into restoration of hypoglycemia awareness in this population. This real world data shows that severe hypoglycemia continues to be a frequent problem in this patient population.

SUBMITTER: Zekarias K

PROVIDER: S-EPMC6289863 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Real life evidence that impaired awareness of hypoglycemia persists for years in patients with type 1 diabetes.

Zekarias K K Kumar A A Moheet A A Seaquist E E

Journal of diabetes and its complications 20180901 12

<h4>Aims</h4>To determine if impaired awareness of hypoglycemia in patients with type 1 diabetes persists over time and to assess if continuous glucose monitoring use was associated with improved awareness of hypoglycemia in our population.<h4>Methods</h4>Thirty-six with type 1 diabetes and impaired awareness of hypoglycemia who participated in studies on impaired awareness of hypoglycemia between 2009 and 2015 were contacted to complete an online survey. The survey included the Cox/Clarke and G ...[more]

PMID: 30301594

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Project description:In this study, we retrospectively analyzed the anatomical MRI data acquired from 52 subjects with type 1 diabetes (26M/26F, 36 ± 11 years old, A1C = 7.2 ± 0.9%) and 50 age, sex and BMI frequency-matched non-diabetic controls (25M/25F, 36 ± 14 years old). The T1D group was further sub-divided based on whether subjects had normal, impaired, or indeterminate awareness of hypoglycemia (n = 31, 20, and 1, respectively). Our goals were to test whether the gray matter (GM) volumes of selected brain regions were associated with diabetes status as well as with the status of hypoglycemia awareness. T1D subjects were found to have slightly smaller volume of the whole cortex as compared to controls (-2.7%, p = 0.016), with the most affected brain region being the frontal lobe (-3.6%, p = 0.024). Similar differences of even larger magnitude were observed among the T1D subjects based on their hypoglycemia awareness status. Indeed, compared to the patients with normal awareness of hypoglycemia, patients with impaired awareness had smaller volume of the whole cortex (-7.9%, p = 0.0009), and in particular of the frontal lobe (-9.1%, p = 0.006), parietal lobe (-8.0%, p = 0.015) and temporal lobe (-8.2%, p = 0.009). Such differences were very similar to those observed between patients with impaired awareness and controls (-7.6%, p = 0.0002 in whole cortex, -9.1%, p = 0.0003 in frontal lobe, -7.8%, p = 0.002 in parietal lobe, and -6.4%, p = 0.019 in temporal lobe). On the other hand, patients with normal awareness did not present significant volume differences compared to controls. No group-differences were observed in the occipital lobe or in the anterior cingulate, posterior cingulate, hippocampus, and thalamus. We conclude that diabetes status is associated with a small but statistically significant reduction of the whole cortex volume, mainly in the frontal lobe. The most prominent structural effects occurred in patients with impaired awareness of hypoglycemia (IAH) as compared to those with normal awareness, perhaps due to the long-term exposure to recurrent episodes of hypoglycemia. Future studies aimed at quantifying relationships of structural outcomes with functional outcomes, with cognitive performance, as well as with parameters describing glucose variability and severity of hypoglycemia episodes, will be necessary to further understand the impact of T1D on the brain.

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Real life evidence that impaired awareness of hypoglycemia persists for years in patients with type 1 diabetes.

Publications

Real life evidence that impaired awareness of hypoglycemia persists for years in patients with type 1 diabetes.

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