Erythropoietin during hypoglycaemia in type 1 diabetes: relation to basal renin-angiotensin system activity and cognitive function

TY - JOUR

T1 - Erythropoietin during hypoglycaemia in type 1 diabetes

T2 - relation to basal renin-angiotensin system activity and cognitive function

AU - Kristensen, Peter Lommer

AU - Høi-Hansen, Thomas

AU - Olsen, Niels Vidiendal

AU - Pedersen-Bjergaard, Ulrik

AU - Thorsteinsson, Birger

PY - 2009/7

Y1 - 2009/7

N2 - AIMS: Preservation of cognitive function during hypoglycaemic episodes is crucial for patients with insulin-treated diabetes to avoid severe hypoglycaemic events. Erythropoietin has neuroprotective potential. However, the role of erythropoietin during hypoglycaemia is unclear. The aim of the study was to explore plasma erythropoietin response to hypoglycaemia and the relationship to basal renin-angiotensin system (RAS) activity and cognitive function.METHODS: We performed a single-blinded, controlled, cross-over study with induced hypoglycaemia or maintained glycaemic level. Nine patients with type 1 diabetes with high and nine with low activity in RAS were studied. Hypoglycaemia was induced using a standardized insulin-infusion.RESULTS: Overall, erythropoietin concentrations increased during hypoglycaemia. In the high RAS group erythropoietin rose 29% (p=0.032) whereas no significant response was observed in the low RAS group (7% increment; p=0.43). Independently, both hypoglycaemia and high RAS activity were associated with higher levels of erythropoietin (p=0.02 and 0.04, respectively). Low plasma erythropoietin at baseline was associated with poorer cognitive performance during hypoglycaemia.CONCLUSIONS: Hypoglycaemia triggers a rise in plasma erythropoietin in patients with type 1 diabetes. The response is influenced by basal RAS activity. Erythropoietin may carry a neuroprotective potential during hypoglycaemia.

AB - AIMS: Preservation of cognitive function during hypoglycaemic episodes is crucial for patients with insulin-treated diabetes to avoid severe hypoglycaemic events. Erythropoietin has neuroprotective potential. However, the role of erythropoietin during hypoglycaemia is unclear. The aim of the study was to explore plasma erythropoietin response to hypoglycaemia and the relationship to basal renin-angiotensin system (RAS) activity and cognitive function.METHODS: We performed a single-blinded, controlled, cross-over study with induced hypoglycaemia or maintained glycaemic level. Nine patients with type 1 diabetes with high and nine with low activity in RAS were studied. Hypoglycaemia was induced using a standardized insulin-infusion.RESULTS: Overall, erythropoietin concentrations increased during hypoglycaemia. In the high RAS group erythropoietin rose 29% (p=0.032) whereas no significant response was observed in the low RAS group (7% increment; p=0.43). Independently, both hypoglycaemia and high RAS activity were associated with higher levels of erythropoietin (p=0.02 and 0.04, respectively). Low plasma erythropoietin at baseline was associated with poorer cognitive performance during hypoglycaemia.CONCLUSIONS: Hypoglycaemia triggers a rise in plasma erythropoietin in patients with type 1 diabetes. The response is influenced by basal RAS activity. Erythropoietin may carry a neuroprotective potential during hypoglycaemia.

KW - Adult

KW - Blood Glucose

KW - C-Peptide

KW - Cognition

KW - Creatinine

KW - Cross-Over Studies

KW - Diabetes Mellitus, Type 1

KW - Erythropoietin

KW - Female

KW - Glomerular Filtration Rate

KW - Hemoglobin A, Glycosylated

KW - Humans

KW - Hypoglycemia

KW - Hypoglycemic Agents

KW - Insulin

KW - Male

KW - Middle Aged

KW - Renin-Angiotensin System

KW - Single-Blind Method

U2 - 10.1016/j.diabres.2009.01.008

DO - 10.1016/j.diabres.2009.01.008

M3 - Journal article

C2 - 19211168

SN - 1572-1671

VL - 85

SP - 75

EP - 84

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

IS - 1

ER -