Association between recent exposure to continuous glucose monitoring-recorded hypoglycaemia and counterregulatory and symptom responses to subsequent controlled hypoglycaemia in people with type 1 diabetes

Cecilie H. Svensson (Lead / Corresponding author), Therese W. Fabricius, Clementine E. M. Verhulst, Peter L. Kristensen, Cees J. Tack, Simon Heller, Stephanie A. Amiel, Rory J. McCrimmon, Mark Evans, Jens J. Holst, Bastiaan E. de Galan, Ulrik Pedersen-Bjergaard, Hypo-RESOLVE Consortium

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    Abstract

    Aim
    Experimental hypoglycaemia blunts the counterregulatory hormone and symptom responses to a subsequent episode of hypoglycaemia. In this study, we aimed to assess the associations between antecedent exposure and continuous glucose monitoring (CGM)-recorded hypoglycaemia during a 1-week period and the counterregulatory responses to subsequent experimental hypoglycaemia in people with type 1 diabetes.
    Materials and Methods
    Forty-two people with type 1 diabetes (20 females, mean ± SD glycated haemoglobin 7.8% ± 1.0%, diabetes duration median (interquartile range) 22.0 (10.5-34.9) years, 29 CGM users, and 19 with impaired awareness of hypoglycaemia) wore an open intermittently scanned CGM for 1 week to detect hypoglycaemic exposure before a standardized hyperinsulinaemic-hypoglycaemic [2.8 ± 0.1 mmol/L (50.2 ± 2.3 mg/dl)] glucose clamp. Symptom responses and counterregulatory hormones were measured during the clamp. The study is part of the HypoRESOLVE project.
    Results
    CGM-recorded hypoglycaemia in the week before the clamp was negatively associated with adrenaline response [β −0.09, 95% CI (−0.16, −0.02) nmol/L, p = .014], after adjusting for CGM use, awareness of hypoglycaemia, glycated haemoglobin and total daily insulin dose. This was driven by level 2 hypoglycaemia [<3.0 mmol/L (54 mg/dl)] [β −0.21, 95% CI (−0.41, −0.01) nmol/L, p = .034]. CGM-recorded hypoglycaemia was negatively associated with total, autonomic, and neuroglycopenic symptom responses, but these associations were lost after adjusting for potential confounders.
    Conclusions
    Recent exposure to CGM-detected hypoglycaemia was independently associated with an attenuated adrenaline response to experimental hypoglycaemia in people with type 1 diabetes.
    Original languageEnglish
    Number of pages10
    JournalDiabetes, Obesity & Metabolism
    Early online date22 May 2024
    DOIs
    Publication statusE-pub ahead of print - 22 May 2024

    Keywords

    • continuous glucose monitoring
    • counterregulation
    • counterregulatory hormone and symptom responses
    • diabetes
    • hyperinsulinaemic-hypoglycaemic clamp
    • hypoglycaemia
    • hypoglycaemia awareness
    • type 1 diabetes

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