Hypoglycemic Exposure and Risk of Asymptomatic Hypoglycemia in Type 1 Diabetes Assessed by Continuous Glucose Monitoring

TY - JOUR

T1 - Hypoglycemic Exposure and Risk of Asymptomatic Hypoglycemia in Type 1 Diabetes Assessed by Continuous Glucose Monitoring

AU - Henriksen, Marie Moth

AU - Andersen, Henrik Ullits

AU - Thorsteinsson, Birger

AU - Pedersen-Bjergaard, Ulrik

PY - 2018

Y1 - 2018

N2 - Context Recurrent hypoglycemia promotes impaired awareness, resulting in an increased risk for asymptomatic hypoglycemia. However, there are no firm data on the frequency of hypoglycemia in daily life needed to initiate this vicious cycle or the role of asymptomatic hypoglycemia. Objective To explore the association between hypoglycemic exposure and proportion of asymptomatic hypoglycemia and relation to risk for severe hypoglycemia. Design Prospective observational trial. Setting Outpatient clinic. Patients One hundred fifty-three unselected patients with type 1 diabetes mellitus (T1D). Intervention Six days of blinded continuous glucose monitoring and recording of hypoglycemia symptoms. Main Outcome Measure Proportion of asymptomatic hypoglycemic events (glucose level ≤70 mg/dL). Results Patients were grouped by the number of hypoglycemic events during the recording period (group 1: one event; group 2: two to three events; group 3: four to six events; group 4: seven or more events), and fractions of asymptomatic events were calculated. Across the four groups, the fraction of asymptomatic hypoglycemia increased: 57% in group 1, 61% in group 2, 65% in group 3, and 80% in group 4 (P < 0.001). Higher fraction of asymptomatic hypoglycemia was positively associated with risk for severe hypoglycemia (incidence rate ratio, 1.3; 95% confidence interval, 1.1 to 1.5; P = 0.003). Group 4 consisted of patients characterized by classic risk factors of severe hypoglycemia (longer duration of diabetes, lower hemoglobin A1c, and more frequent impaired awareness of hypoglycemia). Conclusions Patients with T1D with hypoglycemic rates corresponding to daily exposure had an increased fraction of asymptomatic events, which was positively associated with risk for severe hypoglycemia; therefore, such patients deserve particular attention in clinical practice.

AB - Context Recurrent hypoglycemia promotes impaired awareness, resulting in an increased risk for asymptomatic hypoglycemia. However, there are no firm data on the frequency of hypoglycemia in daily life needed to initiate this vicious cycle or the role of asymptomatic hypoglycemia. Objective To explore the association between hypoglycemic exposure and proportion of asymptomatic hypoglycemia and relation to risk for severe hypoglycemia. Design Prospective observational trial. Setting Outpatient clinic. Patients One hundred fifty-three unselected patients with type 1 diabetes mellitus (T1D). Intervention Six days of blinded continuous glucose monitoring and recording of hypoglycemia symptoms. Main Outcome Measure Proportion of asymptomatic hypoglycemic events (glucose level ≤70 mg/dL). Results Patients were grouped by the number of hypoglycemic events during the recording period (group 1: one event; group 2: two to three events; group 3: four to six events; group 4: seven or more events), and fractions of asymptomatic events were calculated. Across the four groups, the fraction of asymptomatic hypoglycemia increased: 57% in group 1, 61% in group 2, 65% in group 3, and 80% in group 4 (P < 0.001). Higher fraction of asymptomatic hypoglycemia was positively associated with risk for severe hypoglycemia (incidence rate ratio, 1.3; 95% confidence interval, 1.1 to 1.5; P = 0.003). Group 4 consisted of patients characterized by classic risk factors of severe hypoglycemia (longer duration of diabetes, lower hemoglobin A1c, and more frequent impaired awareness of hypoglycemia). Conclusions Patients with T1D with hypoglycemic rates corresponding to daily exposure had an increased fraction of asymptomatic events, which was positively associated with risk for severe hypoglycemia; therefore, such patients deserve particular attention in clinical practice.

U2 - 10.1210/jc.2018-00142

DO - 10.1210/jc.2018-00142

M3 - Journal article

C2 - 29618010

AN - SCOPUS:85048679563

SN - 0021-972X

VL - 103

SP - 2329

EP - 2335

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 6

ER -