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Philip E. Cryer - One of the best experts on this subject based on the ideXlab platform.

  • terbutaline and the prevention of Nocturnal Hypoglycemia in type 1 diabetes
    Diabetes Care, 2008
    Co-Authors: Benjamin A. Cooperberg, Suzanne M. Breckenridge, Ana María Arbeláez, Philip E. Cryer
    Abstract:

    OBJECTIVE—Bedtime administration of 5.0 mg of the β2-adrenergic agonist terbutaline prevents Nocturnal Hypoglycemia but causes morning hyperglycemia in type 1 diabetes. We tested the hypothesis that 2.5 mg terbutaline prevents Nocturnal Hypoglycemia without causing morning hyperglycemia. RESEARCH DESIGN AND METHODS—This was a randomized double-blind crossover pilot study (placebo, 2.5 mg terbutaline, and 5.0 mg terbutaline) in 15 patients with type 1 diabetes. RESULTS—Mean ± SE nadir Nocturnal plasma glucose concentrations were 87 ± 14 mg/dl following placebo, 100 ± 14 mg/dl following 2.5 mg terbutaline, and 122 ± 13 mg/dl following 5.0 mg terbutaline (P < 0.05 vs. placebo). Nadir levels were <50 mg/dl in 5, 2, and 0 patients (P < 0.05 vs. placebo), respectively. Morning levels were 113 ± 18, 127 ± 17, and 183 ± 19 mg/dl (P < 0.02 vs. placebo), respectively. CONCLUSIONS—Terbutaline may be shown to be effective and safe in the prevention of Nocturnal Hypoglycemia in type 1 diabetes in a suitably powered randomized controlled trial.

  • Terbutaline and the Prevention of Nocturnal Hypoglycemia in Type 1 Diabetes
    Diabetes Care, 2008
    Co-Authors: Benjamin A. Cooperberg, Suzanne M. Breckenridge, Ana María Arbeláez, Philip E. Cryer
    Abstract:

    OBJECTIVE—Bedtime administration of 5.0 mg of the β2-adrenergic agonist terbutaline prevents Nocturnal Hypoglycemia but causes morning hyperglycemia in type 1 diabetes. We tested the hypothesis that 2.5 mg terbutaline prevents Nocturnal Hypoglycemia without causing morning hyperglycemia. RESEARCH DESIGN AND METHODS—This was a randomized double-blind crossover pilot study (placebo, 2.5 mg terbutaline, and 5.0 mg terbutaline) in 15 patients with type 1 diabetes. RESULTS—Mean ± SE nadir Nocturnal plasma glucose concentrations were 87 ± 14 mg/dl following placebo, 100 ± 14 mg/dl following 2.5 mg terbutaline, and 122 ± 13 mg/dl following 5.0 mg terbutaline (P < 0.05 vs. placebo). Nadir levels were

  • Nocturnal Hypoglycemia in Type 1 Diabetes: An Assessment of Preventive Bedtime Treatments
    The Journal of Clinical Endocrinology & Metabolism, 2006
    Co-Authors: Bharathi Raju, Suzanne M. Breckenridge, Ana María Arbeláez, Philip E. Cryer
    Abstract:

    Objective: We assessed four putative bedtime treatments in the prevention of Nocturnal Hypoglycemia in type 1 diabetes. Research Design and Methods: Plasma glucose concentrations were measured every 15 min from 2200 h through 0700 h in 21 patients with type 1 diabetes (mean ± sd HbA1C = 7.1 ± 1.0%) on five occasions with, in random sequence, bedtime (2200 h) administration of 1) no treatment, 2) a snack, 3) the snack plus the α-glucosidase inhibitor acarbose, 4) an uncooked cornstarch bar, or 5) the β2-adrenergic agonist terbutaline. Results: In the absence of a bedtime treatment, 27% of the measured Nocturnal plasma glucose concentrations were less than 70 mg/dl (3.9 mmol/liter) in 12 patients; 16, 6, and 1% were less than 60, less than 50, and less than 40 mg/dl (3.3, 2.8, and 2.2 mmol/liter), respectively. Neither the snack (without or with acarbose) nor cornstarch raised the mean nadir Nocturnal glucose concentration or reduced the number of low glucose levels or the number of patients with low levels...

  • Impact of Nocturnal Hypoglycemia on hypoglycemic cognitive dysfunction in type 1 diabetes.
    Diabetes, 1998
    Co-Authors: Carmine G. Fanelli, Deanna S. Paramore, Tamara Hershey, Christoph Terkamp, Fernando Ovalle, Suzanne Craft, Philip E. Cryer
    Abstract:

    To test the hypothesis that glycemic thresholds for cognitive dysfunction during Hypoglycemia, like those for autonomic and symptomatic responses, shift to lower plasma glucose concentrations after recent antecedent Hypoglycemia in patients with type 1 diabetes mellitus (T1DM), 15 patients were studied on two occasions. Cognitive functions were assessed during morning hyperinsulinemic stepped hypoglycemic clamps (85, 75, 65, 55, and 45 mg/dl steps) after, in random sequence, Nocturnal (2330-0300) Hypoglycemia (48 +/- 2 mg/dl) on one occasion and Nocturnal euglycemia (109 +/- 1 mg/dl) on the other. Compared with nondiabetic control subjects (n = 12), patients with T1DM had absent glucagon (P = 0.0009) and reduced epinephrine (P = 0.0010), norepinephrine (P = 0.0001), and neurogenic symptom (P = 0.0480) responses to Hypoglycemia; the epinephrine (P = 0.0460) and neurogenic symptom (P = 0.0480) responses were reduced further after Nocturnal Hypoglycemia. After Nocturnal Hypoglycemia, in contrast to Nocturnal euglycemia, there was less deterioration of cognitive function overall (P = 0.0065) during Hypoglycemia based on analysis of the sum of standardized scores (z-scores). There was relative preservation of measures of pattern recognition and memory (the delayed non-match to sample task, P = 0.0371) and of attention (the Stroop arrow-word task, P = 0.0395), but not of measures of information processing (the paced serial addition task) or declarative memory (the delayed paragraph recall task), after Nocturnal Hypoglycemia. Thus, glycemic thresholds for hypoglycemic cognitive dysfunction, like those for autonomic and symptomatic responses to Hypoglycemia, shift to lower plasma glucose concentrations after recent antecedent Hypoglycemia in patients with T1DM.

  • Alanine and Terbutaline in the Prevention of Nocturnal Hypoglycemia in IDDM
    Diabetes Care, 1997
    Co-Authors: Tarek Y Saleh, Philip E. Cryer
    Abstract:

    OBJECTIVE To test the hypothesis that because of sustained glycemic actions, bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine-simulating β2-adrenergic agonist terbutaline more effectively prevents Nocturnal Hypoglycemia than a conventional bedtime snack, we studied 15 patients with 1DDM. RESEARCH DESIGN AND METHODS On each of four occasions, the same individualized dose of NPH insulin (0.1–0.2 U/kg) was administered with either no treatment (control) or, in random sequence, oral treatment with a snack (240 ml of 2% milk plus one slice of toast, ∼200 kcal), alanine (40 g, plus 10 g of glucose, ∼200 kcal), or terbutaline (5.0 mg) at 2200. RESULTS During the first half of the night (2315–0300), mean plasma glucose concentrations were higher after the snack ( P < 0.02), alanine plus glucose ( P < 0.01), or terbutaline ( P < 0.001), compared with no treatment. During the second half of the night, mean plasma glucose levels were no different from control values (73 ± 5 mg/dl, 4.1 ± 0.3 mmol/1) after the snack (73 ± 7 mg/dl, 4.1 ± 0.4 mmol/1), tended to be higher after alanine plus glucose (96 ± 16 mg/dl, 5.3 ± 0.9 mmol/1), and were significantly higher after terbutaline (124 ± 15 mg/dl, 6.9 ± 0.8 mmol/1, P < 0.01). Nocturnal plasma glucose levels of 40 mg/dl (2.2 mmol/1) or less (which were treated with intravenous glucose) occurred on 13 occasions in seven patients in the control arm and 10 occasions in six patients in the snack arm (not significantly different from the control arm), but on only 1 occasion in the alanine-plus-glucose.arm ( P < 0.02) and the terbutaline arm ( P < 0.02). CONCLUSIONS In patients with 1DDM given an evening dose of NPH insulin, a conventional bedtime snack exerts an inconsistent glycemic effect only during the first half of the night, and bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine- simulating β2-adrenergic agonist terbutaline more effectively prevents Nocturnal Hypoglycemia than a conventional bedtime snack.

Timothy W Jones - One of the best experts on this subject based on the ideXlab platform.

  • electroencephalogram spectral moments for the detection of Nocturnal Hypoglycemia
    IEEE Journal of Biomedical and Health Informatics, 2020
    Co-Authors: Cuong Q Ngo, Rifai Chai, Tuan V Nguyen, Timothy W Jones, Hung T Nguyen
    Abstract:

    Hypoglycemia or low blood glucose is the most feared complication of insulin treatment of diabetes. For people with diabetes, the mismatch between the insulin therapy and the body's physiology could increase the risk of Hypoglycemia. Nocturnal Hypoglycemia is particularly dangerous for type-1 diabetes patients because its symptoms may obscure during sleep. The early onset detection of Hypoglycemia at night time is necessary because it can result in unconsciousness and even death. This paper presents new electroencephalogram spectral features for Nocturnal Hypoglycemia detection. The system uses high-order spectral moments for feature extraction and Bayesian neural network for classification. From a clinical study of Hypoglycemia of eight patients with type-1 diabetes at night, we find that these spectral moments of theta band and alpha band changed significantly. During Hypoglycemia episodes, the theta moments increased significantly ( P P P  < 0.001) with real blood glucose profiles shows the effectiveness of the proposed features for the detection of Nocturnal Hypoglycemia.

  • Electroencephalogram Spectral Moments for the Detection of Nocturnal Hypoglycemia
    IEEE Journal of Biomedical and Health Informatics, 2020
    Co-Authors: Cuong Q Ngo, Rifai Chai, Tuan V Nguyen, Timothy W Jones, Hung T Nguyen
    Abstract:

    Hypoglycemia or low blood glucose is the most feared complication of insulin treatment of diabetes. For people with diabetes, the mismatch between the insulin therapy and the body's physiology could increase the risk of Hypoglycemia. Nocturnal Hypoglycemia is particularly dangerous for type-1 diabetes patients because its symptoms may obscure during sleep. The early onset detection of Hypoglycemia at night time is necessary because it can result in unconsciousness and even death. This paper presents new electroencephalogram spectral features for Nocturnal Hypoglycemia detection. The system uses high-order spectral moments for feature extraction and Bayesian neural network for classification. From a clinical study of Hypoglycemia of eight patients with type-1 diabetes at night, we find that these spectral moments of theta band and alpha band changed significantly. During Hypoglycemia episodes, the theta moments increased significantly ( P P P  

  • occipital eeg activity for the detection of Nocturnal Hypoglycemia
    International Conference of the IEEE Engineering in Medicine and Biology Society, 2018
    Co-Authors: Bao C Q Truong, Timothy W Jones, Hung T Nguyen
    Abstract:

    Nocturnal Hypoglycemia is dangerous that threatens patients because of its unclear symptoms during sleep. This paper is a study of Hypoglycemia from 8 patients with type 1 diabetes (T1D) at night. O1 and O2 EEG data of the occipital lobe associated with glycemic episodes were analyzed. Frequency features were computed from Power Spectral Density using Welch’s method. Centroid alpha frequency reduced significantly ($\mathrm{P}\lt 0.0001$) while centroid theta increased considerably ($\mathrm{P}\lt 0.01$). Spectral entropy of the unified theta-alpha band rose significantly ($\mathrm{P}\lt 0.005$). These occipital features acted as the input of a Bayesian regularized neural network for detecting hypoglycemic episodes. The classification results were 73% and 60% of sensitivity and specificity, respectively.

  • EMBC - Occipital EEG Activity for the Detection of Nocturnal Hypoglycemia
    2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2018
    Co-Authors: Cuong Q Ngo, Timothy W Jones, Bao C Q Truong, Hung T Nguyen
    Abstract:

    Nocturnal Hypoglycemia is dangerous that threatens patients because of its unclear symptoms during sleep. This paper is a study of Hypoglycemia from 8 patients with type 1 diabetes (T1D) at night. O1 and O2 EEG data of the occipital lobe associated with glycemic episodes were analyzed. Frequency features were computed from Power Spectral Density using Welch’s method. Centroid alpha frequency reduced significantly ($\mathrm{P}\lt 0.0001$) while centroid theta increased considerably ($\mathrm{P}\lt 0.01$). Spectral entropy of the unified theta-alpha band rose significantly ($\mathrm{P}\lt 0.005$). These occipital features acted as the input of a Bayesian regularized neural network for detecting hypoglycemic episodes. The classification results were 73% and 60% of sensitivity and specificity, respectively.

  • Clinical Evaluation of a Noninvasive Alarm System for Nocturnal Hypoglycemia
    Journal of Diabetes Science and Technology, 2010
    Co-Authors: Victor Skladnev, Nejhdeh Ghevondian, Stanislav Tarnavskii, Nirubasini Paramalingam, Timothy W Jones
    Abstract:

    Background: The aim of this study was to evaluate the performance of a prototype noninvasive alarm system (HypoMon ® ) for the detection of Nocturnal Hypoglycemia. A prospective cohort study evaluated an alarm system that included a sensor belt, a radio frequency transmitter for chest belt signals, and a receiver. The receiver incorporated integrated “real-time” algorithms designed to recognize Hypoglycemia “signatures” in the physiological parameters monitored by the sensor belt. Methods: Fifty-two children and young adults with type 1 diabetes mellitus (T1DM) participated in this blinded, prospective, in-clinic, overnight study. Participants had a mean age of 16 years (standard deviation 2.1, range 12–20 years) and were asked to follow their normal meal and insulin routines for the day of the study. Participants had physiological parameters monitored overnight by a single HypoMon system. Their BG levels were also monitored overnight at regular intervals via an intravenous cannula and read on two independent Yellow Springs Instruments analyzers. Hypoglycemia was not induced by any manipulations of diabetes management, rather the subjects were monitored overnight for “natural” occurrences of Hypoglycemia. Performance analyses included comparing HypoMon system alarm times with allowed time windows associated with each hypoglycemic event. Results: The primary recognition algorithm in the prototype alarm system performed at a level consistent with expectations based on prior user surveys. The HypoMon system correctly recognized 8 out of the 11 naturally occurring overnight hypoglycemic events and falsely alarmed on 13 out of the remaining 41 normal nights [sensitivity 73% (8/11), specificity 68% (28/41), positive predictive value 38%,negative predictive value 90%]. continued

Krystyna Matyka - One of the best experts on this subject based on the ideXlab platform.

  • Sweet dreams? – Nocturnal Hypoglycemia in children with type 1 diabetes
    Pediatric Diabetes, 2002
    Co-Authors: Krystyna Matyka
    Abstract:

    Hypoglycemia is an inevitable consequence of the treatment of type 1 diabetes in childhood. Nocturnal Hypoglycemia is often considered as merely the submerged part of this serious complication yet there are reasons to believe that Hypoglycemia occurring during sleep may be different in physiological terms. Glucose homeostasis during fasting, delayed effects of exercise and alterations in sleep physiology, itself, may not only affect the risk of Nocturnal Hypoglycemia but may influence the ability to correct glucose concentration as it falls, leading to episodes of Hypoglycemia which are both profound and prolonged. The etiology and potential repercussions are incompletely understood and the most appropriate defense remains unclear. A greater understanding of this enigmatic phenomenon is essential before appropriate methods for Hypoglycemia avoidance can be developed.

  • sweet dreams Nocturnal Hypoglycemia in children with type 1 diabetes
    Pediatric Diabetes, 2002
    Co-Authors: Krystyna Matyka
    Abstract:

    Hypoglycemia is an inevitable consequence of the treatment of type 1 diabetes in childhood. Nocturnal Hypoglycemia is often considered as merely the submerged part of this serious complication yet there are reasons to believe that Hypoglycemia occurring during sleep may be different in physiological terms. Glucose homeostasis during fasting, delayed effects of exercise and alterations in sleep physiology, itself, may not only affect the risk of Nocturnal Hypoglycemia but may influence the ability to correct glucose concentration as it falls, leading to episodes of Hypoglycemia which are both profound and prolonged. The etiology and potential repercussions are incompletely understood and the most appropriate defense remains unclear. A greater understanding of this enigmatic phenomenon is essential before appropriate methods for Hypoglycemia avoidance can be developed.

Simon Heller - One of the best experts on this subject based on the ideXlab platform.

  • target fasting plasma glucose fpg without Nocturnal Hypoglycemia in patients with type 1 diabetes or type 2 diabetes results from switch trials
    Diabetes, 2018
    Co-Authors: Carol H. Wysham, Wendy Lane, Steen Ladelund, Deniz Tutkunkardas, Simon Heller
    Abstract:

    Insulin degludec (degludec) is a basal insulin that results in a lower FPG than insulin glargine 100 units/mL (glargine U100), which may increase the risk of Nocturnal Hypoglycemia in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). This post-hoc analysis investigated the proportion of patients with T1D or T2D treated with degludec or glargine U100 meeting the ADA recommended upper limit of the pre-meal plasma glucose goal of In conclusion, compared with glargine U100, treatment with degludec was associated with greater opportunity to reach target FPG without an increased risk of Nocturnal Hypoglycemia. Disclosure C.H. Wysham: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Sanofi. Consultant; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Speaker9s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. W. Lane: Advisory Panel; Self; Novo Nordisk A/S, Insulet Corporation, Intarcia Therapeutics, Inc., Sanofi. Research Support; Self; Novo Nordisk A/S, Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Sanofi, Dexcom, Inc.. Speaker9s Bureau; Self; Novo Nordisk A/S, Insulet Corporation. S. Ladelund: Employee; Self; Novo Nordisk A/S, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Technical University of Denmark. Research Support; Self; Metropolitan University College, Denmark. D. Tutkunkardas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. S. Heller: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Takeda, Sanofi-Aventis, Boehringer Ingelheim GmbH. Consultant; Self; Eli Lilly and Company, Novo Nordisk A/S. Speaker9s Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Merck Sharp & Dohme Corp., Takeda, AstraZeneca, Boehringer Ingelheim GmbH.

  • Target Fasting Plasma Glucose (FPG) without Nocturnal Hypoglycemia in Patients with Type 1 Diabetes or Type 2 Diabetes—Results from SWITCH Trials
    Diabetes, 2018
    Co-Authors: Carol H. Wysham, Wendy Lane, Steen Ladelund, Deniz Tutkunkardas, Simon Heller
    Abstract:

    Insulin degludec (degludec) is a basal insulin that results in a lower FPG than insulin glargine 100 units/mL (glargine U100), which may increase the risk of Nocturnal Hypoglycemia in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). This post-hoc analysis investigated the proportion of patients with T1D or T2D treated with degludec or glargine U100 meeting the ADA recommended upper limit of the pre-meal plasma glucose goal of In conclusion, compared with glargine U100, treatment with degludec was associated with greater opportunity to reach target FPG without an increased risk of Nocturnal Hypoglycemia. Disclosure C.H. Wysham: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Sanofi. Consultant; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Speaker9s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. W. Lane: Advisory Panel; Self; Novo Nordisk A/S, Insulet Corporation, Intarcia Therapeutics, Inc., Sanofi. Research Support; Self; Novo Nordisk A/S, Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Sanofi, Dexcom, Inc.. Speaker9s Bureau; Self; Novo Nordisk A/S, Insulet Corporation. S. Ladelund: Employee; Self; Novo Nordisk A/S, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Technical University of Denmark. Research Support; Self; Metropolitan University College, Denmark. D. Tutkunkardas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. S. Heller: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Takeda, Sanofi-Aventis, Boehringer Ingelheim GmbH. Consultant; Self; Eli Lilly and Company, Novo Nordisk A/S. Speaker9s Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Merck Sharp & Dohme Corp., Takeda, AstraZeneca, Boehringer Ingelheim GmbH.

Dalong Zhu - One of the best experts on this subject based on the ideXlab platform.

  • value of capillary glucose profiles in assessing risk of Nocturnal Hypoglycemia in type 1 diabetes based on continuous glucose monitoring
    Diabetes Therapy, 2020
    Co-Authors: Qing Ling, Chengcheng Qiao, Dalong Zhu
    Abstract:

    This study aimed to evaluate the occurrence of Nocturnal Hypoglycemia in type 1 diabetes (T1D) based on continuous glucose monitoring (CGM), and to explore the value of capillary glucose profiles in assessing the risk of Nocturnal Hypoglycemia. The study also intended to develop a predictive model to identify people with high risk of Nocturnal Hypoglycemia. A total of 169 participants with T1D received 3 days of blinded CGM; meanwhile, their self-monitoring blood glucose (SMBG) profiles were recorded. Logistic regression analyses were used to evaluate contributory factors of Nocturnal Hypoglycemia. Potential indicators were estimated using area under receiver operator curve (AUC) analyses. During the retrospective CGM period, 95 (56.2%) participants with T1D reported 238 events of Hypoglycemia, and 69 (29.0%) of these episodes occurred during the nighttime. Increased risk of Nocturnal Hypoglycemia correlated with lower HbA1c, glycated albumin, and mean blood glucose (OR = 0.790, 0.940, 0.651, respectively; P < 0.05) and higher standard deviation, mean amplitude of glycemic excursions, and low blood glucose index (OR = 1.463, 1.168, 4.035, respectively; P < 0.05) after adjustment for age and duration. Of the daily SMBG profiles, fasting blood glucose (OR = 0.643, P = 0.001) and blood glucose at bedtime (OR = 0.851, P = 0.037) were associated with the occurrence of Nocturnal Hypoglycemia. The BGn model, which was derived from the variation of capillary glucose, could discriminate individuals with increased risk of Nocturnal Hypoglycemia (AUC = 0.774). Nocturnal Hypoglycemia constitutes nearly one-third of hypoglycemic events in people with T1D. Strict glycemic control and great fluctuation of glucose are potential contributory factors. Daily SMBG profiles and the BGn model could help assess the risk of Nocturnal Hypoglycemia in T1D, which may support further development of preventive strategies.

  • Value of Capillary Glucose Profiles in Assessing Risk of Nocturnal Hypoglycemia in Type 1 Diabetes Based on Continuous Glucose Monitoring.
    Diabetes Therapy, 2020
    Co-Authors: Qing Ling, Chengcheng Qiao, Dalong Zhu
    Abstract:

    This study aimed to evaluate the occurrence of Nocturnal Hypoglycemia in type 1 diabetes (T1D) based on continuous glucose monitoring (CGM), and to explore the value of capillary glucose profiles in assessing the risk of Nocturnal Hypoglycemia. The study also intended to develop a predictive model to identify people with high risk of Nocturnal Hypoglycemia. A total of 169 participants with T1D received 3 days of blinded CGM; meanwhile, their self-monitoring blood glucose (SMBG) profiles were recorded. Logistic regression analyses were used to evaluate contributory factors of Nocturnal Hypoglycemia. Potential indicators were estimated using area under receiver operator curve (AUC) analyses. During the retrospective CGM period, 95 (56.2%) participants with T1D reported 238 events of Hypoglycemia, and 69 (29.0%) of these episodes occurred during the nighttime. Increased risk of Nocturnal Hypoglycemia correlated with lower HbA1c, glycated albumin, and mean blood glucose (OR = 0.790, 0.940, 0.651, respectively; P 

  • value of daily capillary blood glucose profiles in assessing Nocturnal Hypoglycemia of type 1 diabetes mellitus based on continuous blood glucose monitoring system
    Chin J Diabetes Mellitus, 2019
    Co-Authors: Qing Ling, Chengcheng Qiao, Dalong Zhu
    Abstract:

    Objective To investigate the incidence and risk factors of Nocturnal Hypoglycemia in type 1 diabetes mellitus (T1DM), and to explore whether Nocturnal Hypoglycemia can be evaluated by daily capillary blood glucose profiles. Methods A total of 137 T1DM patients hospitalized in Nanjing Drum Tower Hospital between May 2013 and August 2018 were recruited and received continuous glucose monitoring (CGM) for 3 consecutive days during stable therapy period, meanwhile capillary blood glucose measurements (before and after 3 meals as well as at bedtime) were recorded. From data of CGM, the patients were divided into Nocturnal Hypoglycemia group and non-Hypoglycemia group. The demographics, laboratory measurements and dynamic blood glucose parameters were compared between these two groups. Receiver operating characteristic curve (ROC) was used to analyze the optimal cut-off points of fasting blood glucose, postprandial blood glucose, bedtime blood glucose and BGn was used to predict Nocturnal Hypoglycemia. Multiple regression analysis was used to evaluate the risk factors of Nocturnal Hypoglycemia. Results (1) Totally, 179 hypoglycemic profiles monitored by CGM were recorded in 137 patients with T1DM, including 50 Nocturnal hypoglycemic episodes occurred in 31 patients (27.9%). (2) Logistic regression analysis indicated that glycated hemoglobin A1c (HbA1c), glycated albumin and mean blood glucose were independent negatively correlated with Nocturnal Hypoglycemia (OR=0.784, 0.021, 0.751, P<0.05), while standard deviation of blood glucose and low blood glucose index were independent positively correlated with Nocturnal Hypoglycemia (OR=1.641, 3.004, P<0.05). (3) Of the daily capillary blood glucose profiles, levels of fasting blood glucose, blood glucose after dinner and blood glucose at bedtime were independently negative correlated with Nocturnal Hypoglycemia (OR=0.257, 0.685, 0.708, P<0.05). The cut-off values for prediction of Nocturnal Hypoglycemia were as follows: levels of fasting glucose was 5.8 mmol/L [sensitivity 80%, specificity 90%, area under curvel (AUC) 0.91], levels of blood glucose after dinner was 8.2 mmol/L (sensitivity 57%, specificity 76%, AUC 0.72), levels of blood glucose at bedtime was 6.7 mmol/L (sensitivity 64%, specificity 90%, AUC 0.80). (4) Based on the capillary blood glucose profiles before meals and at bedtime, a model was established for the prediction of Nocturnal Hypoglycemia: BGn=bedtime blood glucose × (1-SDSM/MBGSM). When BGn was 5.2 mmol/L, the specificity increased to 93% and AUC was 0.81. Conclusion Nocturnal Hypoglycemia is common in patients with T1DM, and individualized blood glucose control targets should be set. Potential increased risk factors of Nocturnal Hypoglycemia were as follows: the levels of fasting blood glucose in the morning is below 5.8 mmol/L, the levels of blood glucose at bedtime is below 6.7 mmol/L or the model of BGn is below 5.2 mmol/L. Key words: Type 1 diabetes; Nocturnal Hypoglycemia; Capillary blood glucose monitoring; Continuous glucose monitoring

  • Value of daily capillary blood glucose profiles in assessing Nocturnal Hypoglycemia of type 1 diabetes mellitus based on continuous blood glucose monitoring system
    2019
    Co-Authors: Qing Ling, Chengcheng Qiao, Dalong Zhu
    Abstract:

    Objective To investigate the incidence and risk factors of Nocturnal Hypoglycemia in type 1 diabetes mellitus (T1DM), and to explore whether Nocturnal Hypoglycemia can be evaluated by daily capillary blood glucose profiles. Methods A total of 137 T1DM patients hospitalized in Nanjing Drum Tower Hospital between May 2013 and August 2018 were recruited and received continuous glucose monitoring (CGM) for 3 consecutive days during stable therapy period, meanwhile capillary blood glucose measurements (before and after 3 meals as well as at bedtime) were recorded. From data of CGM, the patients were divided into Nocturnal Hypoglycemia group and non-Hypoglycemia group. The demographics, laboratory measurements and dynamic blood glucose parameters were compared between these two groups. Receiver operating characteristic curve (ROC) was used to analyze the optimal cut-off points of fasting blood glucose, postprandial blood glucose, bedtime blood glucose and BGn was used to predict Nocturnal Hypoglycemia. Multiple regression analysis was used to evaluate the risk factors of Nocturnal Hypoglycemia. Results (1) Totally, 179 hypoglycemic profiles monitored by CGM were recorded in 137 patients with T1DM, including 50 Nocturnal hypoglycemic episodes occurred in 31 patients (27.9%). (2) Logistic regression analysis indicated that glycated hemoglobin A1c (HbA1c), glycated albumin and mean blood glucose were independent negatively correlated with Nocturnal Hypoglycemia (OR=0.784, 0.021, 0.751, P