Clinical factors affecting the perception of hypoglycemia in type 1 diabetes patients treated with personal insulin pumps

• Autorzy: Matejko B. , Grzanka M. , Kiec-Wilk B. , Malecki M. T. , Klupa T.
• Języki publikacji: EN

Abstrakty

EN

Introduction and Objective. The ability to perceive the symptoms of hypoglycemia during the early decrease in plasma glucose concentration may be critical for the safety of T1DM patients treated with intensive insulin therapy, including those treated with continuous subcutaneous insulin infusion (CSII). In the presented observational study an attempt was made to asses clinical factors that might affect subjective awareness of hypoglycemia in CSII-treated T1DM patients, with special attention to factors specific for this mode of treatment. Materials and Methods. For the purpose of the study, data of 110 CSII-treated T1DM patients were collected (78 females and 32 males). The records were analyzed from glucose meters (200-300 measurements/download, depending on meter type) and insulin pumps (total insulin dose, basal/bolus ratio, number of boluses/day, bolus calculator and dual wave/square bolus usage, continuous glucose monitoring data) from the last 3 years. Results. It was found that the level of subjective hypoglycemia perception inversely correlated with the number of hypoglycemic episodes per 100 measurements, age, duration of diabetes, time on insulin pump, and positively correlated with mean glycemia (n = 98; r = 0.22; p = 0.0286). With respect to CSII-related factors, hypoglycemia perception inversely correlated with the percentage of basal insulin (n = 106; r = -0.20; p = 0.0354). In stepwise regression analysis, independent predictors for impaired hypoglycemia perception were: age β = -0.29 (p = 0.023), duration of diabetes β = -0.24 (p = 0.029) and number of the hypoglycemia episodes for 100 measurements β = -0.33 (p = 0.0005). Conclusions. Risk factors for impaired hypoglycemia perception in CSII-treated patients include those identified previously for the general population of T1DM individuals. In addition, the presented results suggest that a higher basal/bolus ratio may lead to impairment of the ability to perceive early symptoms of hypoglycemia.

• Wydawca: -
• Czasopismo: Annals of Agricultural and Environmental Medicine
• Rocznik: 2013
• Tom: 20
• Numer: 1
• Opis fizyczny: p.152-154,fig.,ref.

Twórcy

autor

Matejko B.

autor

Grzanka M.

autor

Kiec-Wilk B.

autor

Malecki M. T.

autor

Klupa T.

Bibliografia

• 1. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development andprogression of long term complications in insulin-dependent diabetesmellitus. N Engl J Med. 1993; 329: 977-986.
• 2. Amiel SA, Sherwin RS, Simonson DC, Tamborlane WV. Effect of intensive insulin therapy on glycemic thresholds for counterregulatoryhormone release. Diabetes. 1988; 37: 901-907.
• 3. Cryer PE. Hypoglycemia in diabetes mellitus. In Hypoglycemia: Pathophysiology, Diagnosis and Treatment. New York/Oxford, OxfordUniversity Press. 1997: 91-125.
• 4. Deary IJ, Hepburn DA, MacLeod KM, Frier BM. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factoranalysis. Diabetologia. 1993; 36: 771-777.
• 5. Irvine AA, Cox D, Gonder-Frederick L. Fear of hypoglycemia: relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus. Health Psychol. 1992; 11(2): 135-8.
• 6. Ogundipe OO, Geddes J, Leckie AM, Frier BM. Impaired hypoglycaemia awareness and employment in people with Type 1 diabetes. OccupMed(Lond). 2011; 61(4): 241-6.
• 7. Misso ML, Egberts KJ, Page M, O’Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injectionsfor type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010; 1:CD005103.
• 8. Pickup J, Keen H: Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy intype 1 diabetes. Diabetes Care. 2002; 25: 593-598.
• 9. Pickup JC. Insulin-pump therapy for type 1 diabetes mellitus. N Engl J Med. 2012; 26; 366(17): 1616-24.
• 10. Giménez M, Lara M, Conget I. Sustained efficacy of continuous subcutaneous insulin infusion in type 1 diabetes subjects with recurrentnon-severe and severe hypoglycemia and hypoglycemia unawareness:a pilot study. Diabetes Technol Ther. 2010; 12(7): 517-21.
• 11. Thomas RM, Aldibbiat A, Griffin W, Cox MA, Leech NJ, Shaw JA. A randomized pilot study in Type 1 diabetes complicated by severehypoglycaemia, comparing rigorous hypoglycaemia avoidance withinsulin analogue therapy, CSII or education alone. Diabet Med. 2007;24(7): 778-83.
• 12. Fanelli CG, Epifano L, Rambotti AM, Pampanelli S, Di Vincenzo A, Modarelli F, et al. Meticulous prevention of hypoglycaemianormalizes the glycaemic thresholds and magnitude of most ofneuroendocrine responses to, symptoms of, and cognitive functionduring hypoglycaemia in intensively treated patients with short- termIDDM. Diabetes. 1993; 42: 1683-1689.
• 13. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycaemia unawareness, but not defective glucose counterregulation, in IDDM.Diabetes. 1994; 43: 1426-1434.
• 14. Ovalle F, Fanelli CG, Paramore DS, Hershey T, Craft S, Cryer PE. Brief Twice – Weekly Episodes of Hypoglycemia Reduce Detection of Clinical Hypoglycemia in Type 1 Diabetes Mellitus. Diabetes. 1998;47: 1472-1479.
• 15. Philip E. Cryer. Hypoglycemia in Type 1 Diabetes Mellitus. Endocrinol Metab Clin North Am. 2010; 39(3): 641-654.
• 16. Hepburn DA, Patrick AW, Eadington DW, Ewing DJ, Frier BM. Unawareness of hypoglycaemia in insulin-treated diabetic patients:prevalence and relationship to autonomic neuropathy. Diabet Med.1990; 7: 711-7.
• 17. Ooi C, Mullen P, Williams G. Insulin lispro: the ideal pump insulin for patients with severe hypoglycemic unawareness? Diabetes Care.1999; 22(9): 1598-9.
• 18. Blasetti A, Di Giulio C, Tocco AM, Verrotti A, Tumini S, Chiarelli F, Altobelli E. Variables associated with severe hypoglycemia in childrenand adolescents with type 1 diabetes: a population-based study. PediatrDiabetes. 2011; 12(1): 4-10.
• 19. Bachran R, Beyer P, Klinkert C, Heidtmann B, Rosenbauer J, Holl RW. German/Austrian DPV Initiative; German Pediatric CSII WorkingGroup; BMBF Competence Network Diabetes. Basal rates and circadianprofiles in continuous subcutaneous insulin infusion (CSII) differ forpreschool children, prepubertal children, adolescents and young adults.Pediatr Diabetes. 2012; 13(1): 1-5.
• 20. Matejko B, Cyganek K, Katra B, Galicka-Latala D, Grzanka M, Malecki MT, Klupa T. Insulin pump therapy is equally effective and safe inelderly and young type 1 diabetes patients. Rev Diabet Stud. 2011;8(2): 254-8.

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