Automated Insulin Delivery for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes with Hypoglycemia Unawareness
Authors' conclusion
AID led to a sustained reduction of hypoglycemia exposure. EGP in response to insulin-induced hypoglycemia remained defective, however, partial recovery of glucose counterregulation was evidenced by a reduction in peripheral glucose utilization likely mediated by increased epinephrine secretion and, together with improved autonomic symptoms, may contribute to the observed clinical reduction in hypoglycemia.
Study context
- Population
- Long-standing T1D with impaired awareness of hypoglycemia; mean ± SD age 49 ± 16 years, diabetes duration 34 ± 16 years
- Participants
- 10 participants
- Comparison
- Automated insulin delivery (AID), pre vs post intervention
- AIDn = 10
- Outcome
- Hypoglycemia avoidance and glucose counterregulatory responses to insulin-induced hypoglycemia
- Follow-up
- 18 months
Methodological details18-month follow-up, hyperinsulinemic hypoglycemic clamp, CGM paired with actigraphy every 3 months; clamps at baseline, 6 and 18 months
- 18-month follow-up
- Hyperinsulinemic hypoglycemic clamp
- CGM paired with actigraphy every 3 months; clamps at baseline, 6 and 18 months
Main finding
As reported in the abstract
- Hypoglycemia exposure reduced by 3 months, especially during sleep, sustained through 18 months
- P ≤ 0.001
- Reduced glucose variability
- P < 0.01
Further findings
Hypoglycemia awareness and severity scores
- Improved
- P < 0.01
Severe hypoglycemia events, events/person·year · baseline to postintervention
- Baseline, median (IQR)
- 3 (3-10)
- Postintervention, median (IQR)
- 0 (0-1)
- P
- P = 0.005
Endogenous glucose production (EGP) response during hypoglycemic clamp
- No change in EGP response
Peripheral glucose utilization during hypoglycemia, mg/(kg·min) · pre, 6 and 18 months
- Pre
- 4.6 ± 0.4
- 6 months
- 3.8 ± 0.5
- 18 months
- 3.4 ± 0.3
- Reduced following intervention
- P < 0.05
Pancreatic polypeptide response, pmol/L · pre, 6 and 18 months
- Pre
- 62 ± 29
- 6 months
- 127 ± 44
- 18 months
- 176 ± 58
- Increase over time
- P < 0.01
Epinephrine response, pg/mL · pre, 6 and 18 months
- Pre
- 199 ± 53
- 6 months
- 332 ± 91
- 18 months
- 386 ± 95
- Increase over time
- P = 0.001
Autonomic symptom response · pre, 6 and 18 months
- Pre
- 6 ± 2
- 6 months
- 6 ± 2
- 18 months
- 10 ± 2
- Increase over time
- P < 0.05
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →