Types Of Hypoglycemia Research Articles

PDB28 A HEALTH ECONOMIC AND DECISION MODELLING ANALYSIS PLAN FOR AN INTEGRATED DATABASE OF OVER 100 CLINICAL TRIALS MEASURING HYPOGLYCAEMIC ATTACKS FOR PEOPLE WITH DIABETES: A HEDMAP FOR HYPORESOLVE

Describe a protocol for Health care resource use analysis of an integrated database of over 100 clinical trials measuring hypoglycaemic attacks for people with diabetes. Trials to include are prioritized on sample size, follow- times and data availability on blood glucose, hypoglycemic events, PROs, cardiovascular events, hospitalizations, and mortality. The project will iteratively harmonize, structure and integrate the data-sets. Statistical analyses will determine likelihood and scale of different types of resource use for different types of hypoglycemia. They will quantify the probability of having a hypo, and the conditional probability of using each type of resource (e.g. paramedic, A&E, admission to a general ward), and the scale of resource used. We will further examine the effect of recurrent hypoglycemia on future resource use (e.g. insulin dose change, or HbA1c change). Unit costing of resource use items will be conducted for 5 European countries (France, Germany, Italy, Spain, and UK) to enable costing of each type of hypoglycemic event in each country. The analysis plan provides a coherent assessment of healthcare resource use associations with hypoglycemia adjusting for observed covariates within the integrated trial data-set. The analyses described will be implemented during 2020 and 2021. We will compare our results with a literature search for existing Real World Evidence studies on the costs of hypoglycemia. This study will provide the first detailed integrated analysis of over 100 trials the healthcare resource use associated with hypoglycemic events. Alongside this work, the Hypo-RESOLVE research will develop a new (or refine an existing) patient reported outcome measure focused on hypoglycaemia. This will enable both the companies that develop interventions and the regulatory and reimbursement authorities that assess them, to understand the value of hypoglycemia reducing approaches both on costs and health related quality of life.

EFFECT OF DOUBLE HYPOGLYCEMIC THERAPY WITH METFORMIN AND SAXAGLIPTIN, ON ACHIEVEMENT OF GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES AND ADJUVANT OBESITY

The main goals of the current research on the management of patients with type 2 diabetes are the assessment of the effects of early intensive glycemic control on the development and progression of the disease and its complications and the discovery of the clinical benefits of various types of hypoglycemia. Given the convincing evidence of beneficial effects on the course of the disease, inhibitors of dipeptidyl peptidase-4, primarily saxagliptin, should be considered as a group of first-line hypoglycemic therapy, along with metformin, in the treatment of patients with high-risk type 2 diabetes with concomitant diseases. In a study involving 31 patients with type 2 diabetes, obesity and inadequate glycemic control, on the background of recommended monotherapy metformin, the effectiveness of combination therapy with saxagliptin and metformin was demonstrated. The comparison group consisted of 29 patients with monotherapy metformin at a dose of 2000 mg per day. In most patients receiving saxagliptin at a dose of 5 mg in combination with metformin, a decrease in HbA1c, glucose uptake and postprandial glycaemia was observed compared to baseline values. These results were also more significant compared to the metformin monotherapy group. In addition, the appointment of combination therapy contributed to the improvement of functional activity of - cells of the pancreas. The obtained results allow us to recommend this scheme of combination therapy for the management of patients with type 2 diabetes with obesity.

The efficacy of insulin glargine under real clinical practice conditions: results of the LAURUS-2 observational program

The objective of the Program is to estimate the efficacy and safety of insulin glargine (Lantus) used in routine clinical practice for the treatment of patients presenting with type 2 diabetes mellitus who failed to reach adequate compensation of the disease by therapy with two hyperglycemic agents in combination with NPH insulin and have a glycated hemoglobin level in excess of 7.0%. The data obtained by examining 2395 patients (755 men and 1640 women) were available for analysis. 2157 patients (685 men and 1472 women) were transferred to insulin glargine therapy whereas the remaining 238 ones (70 men and 168 women) continued to use NPH insulin. The patients of the former group were offered two algorithms for dose titration of glargine (Lantus). Significant improvement of the parameters of carbohydrate metabolism was achieved within 12 weeks after the onset of therapy without the risk of hypoglycemia. It is concluded that the results of the Program demonstrate a higher efficacy and safety of insulin glargine compared with NPH insulin for the treatment of the patients with type 2 diabetes mellitus. The use of a simple dose titration algorithm and glycemic self-control makes it possible to quickly, safely, and efficiently achieve optimal parameters of carbohydrate metabolism in the majority of the patients treated with insulin glargine at a low incidence of episodes of all types of hypoglycemia.

Hyperinsulinemic Hypoglycemias in Infancy and Childhood - Diagnostic Therapeutic Algorithm with Contribution of Two Cases

Hypoglycemia is not an independent diagnosis. It is a pathophysiological syndrome whose cause needs to be identified. Identifying it is just the first step to making the diagnosis as precisely as possible and to preventing brain damage. Timely diagnosis and treatment are factors of paramount importance for the prognosis of affected patients. The aim of this study was to present two of our patients with hyperinsulinemic hypoglycemia because of the rarity of the condition and to propose a diagnostic-therapeutic algorithm of hypoglycemic syndrome in childhood. Identifying the genetic mutations using DNA analysis for both children enabled us to determine the prognosis and to provide genetic counseling about the next pregnancies in the affected families. We make a detailed classification of different types of hypoglycemia and the various therapeutic modalities: dietary, medicinal and surgical depending on the etiology. It is concluded that the highly specialized examinations which ensure the etiological diagnose, treatment, prognosis and genetic consultation demand the participation of a well trained medical team--both in the clinical division and in the laboratory.

Hypoglycemia in Ketotic Cows

Two types of hypoglycemia have been differentiated in ketotic cows by tracer parkinetics. One is associated with fasting kebetosis and is characterized by decreases in the mass of glucose in rapid exchange with plasma glucose and in the rate of glucose transport through this pool. The other occurs in cows with spontaneous ketosis and is characterized by undiminished glucose transport or mass and by changes in glucose distribution. Similar changes follow insulin administration and opposite changes follow glucocorticoid administration. These differences in glucose kinetics between fasting ketosis and spontaneous ketosis are complemented by a dozen other demonstrated differences between the two conditions, mainly concerning ruminal, hepatic and mammary metabolism. These metabolic differences suggest the desirability of distinguishing between different types of ketosis for designing and testing control measures.

Diagnostic value of sodium tolbutamide test in hypoglycemia.

The intravenous Na-tolbutamide test was done on various types of hypoglyce-mia and the following conclusions were obtained: (1) Though very useful in the screening of hypoglycemia, the test is not always satisfactory for the differential diagnosis of various types of hypoglycemia. (2) The diagnosis of hypoglycemia by means of the Na-tolbutamide test is con-sidered practically established when the recovering ability from hypoglycemic levels is absent or insufficient, so as to give a value of the recovery index mostly 0.5 or less, and the stationary value is not higher than 55mg/100ml. (3) Pronounced hypoglycemia occasionally persists in some cases of functional hypoglycemia. Temporary rise in the blood sugar levels is observed in some cases of pancreatic hyperinsulinism. Differential diagnosis between the two types of hypoglycemia is impossible when only the Na-tolbutamide test is employed. (4) In a patient with diabetes complicated with hypoglycemia, the blood sugar level 20 and 30 minutes after intravenous tolbutamide injection showed an obvious decrease in the decline rate. (5) Biphasic fluctuations of blood sugar levels after intravenous tolbutamide injection were observed in three cases of hyperinsulinism.

GLUCOSE KINETICS IN NORMAL, FASTING, AND INSULIN-TREATED COWS.

Plasma glucose concentration in four cows averaged 58 mg/100 ml. It fell to 48 mg/100 ml during fasting, and to 29 mg/100 ml when long-acting insulin was given daily. From 45 until 150 min after a single injection of glucose-C14 the curves for plasma glucose specific activity plotted logarithmically against time approximated straight lines. The line during fasting lay above the normal line, while the line during insulin treatment fell below it. This suggests that there are two types of hypoglycemia, distinguished by different changes in the glucose pool. Characteristics of the pool sampled as plasma glucose were calculated from the slope and intercept of the lines from 45 to 150 min after injection. During fasting, the amount of exchangeable glucose fell to two-thirds and the glucose entry rate to half normal. This suggests that hypoglycemia develops during fasting because glucose utilization (outflow) exceeds glucose formation (inflow) with a decrease in the amount of glucose. In contrast, during insulin administration, the amount of exchangeable glucose was greater than normal, the entry rate was increased by one-third, and the apparent volume of glucose distribution was increased to 64% of the body weight. This suggests that insulin-induced hypoglycemia is due to an increase in the glucose "space" associated with the accumulation of exchangeable glucose inside some cells.

Medical aspects of hypoglycemia.

THIS paper is devoted to a general discussion of the various types of hypoglycemia, with a report of representative cases. Elsewhere (1) an effort has been made to separate hyperinsulinism. from all other causes of hypoglycemia. The term “hyperinsulinisin” should be reserved for those patients in whom a hyperfunctioning tumor of the islets of Langerhans has been demonstrated, or who have received an injection of an excessive amount of insulin. Many other causes of hypoglycemia will be found in the classification by Conn (2) (Table 1), some of which are discussed later in the paper. The term “functional hypoglycemia” as defined by him (2) refers to a disturbance in the nervous regulation of the concentration of blood sugar, manifested by hypoglycemic symptoms following meals of average or high carbohydrate content in a patient with increased emotional instability. Throughout this paper, the values given for blood sugar were determined by the Folin-Wu method.

INSULIN HYPOGLYCEMIA IN EPILEPSY

In this study epileptic patients were given injections of insulin for the purpose of determining the role of hypoglycemia in precipitating seizures. Reports of many studies have appeared in the literature suggesting that epileptic attacks may be due to hypoglycemia. On the whole, the evidence has been indirect and not conclusive. Recent clinical knowledge of hyperinsulinism and other types of hypoglycemia has aroused attention anew to this problem. Harris 1 reported three cases of hyperinsulinism and collected reports of twelve others (twelve of fifty recorded cases) in which convulsions were the predominant symptom. In several of these cases a diagnosis of epilepsy was made at first. The injection of insulin is known to induce convulsions in several species of animals. In fact, insulin was formerly assayed in rabbits by this method. Convulsions resulting from an overdose of insulin are of infrequent occurrence in adult human beings. Still, if hypoglycemia bears

HYPOGLYCEMIA

The spontaneous appearance of hypoglycemia may result from certain abnormalities of any of the factors controlling carbohydrate metabolism. A survey of the literature indicates that the condition may arise in the most diverse clinical states. In the present article, we undertake a classification of the various types of hypoglycemia, citing illustrative examples of each. Since pancreatic hypoglycemia appears most frequently clinically, this form has been emphasized by a detailed review of the syndrome based on an analysis of the reported cases. A report is given of a patient suffering from hypoglycemia of pancreatic origin. Tables abstracting the details of the available reports on pancreatic hypoglycemia and of leading cases of the other types are included. In order better to orient the discussion, we present a classification of the diseases in which hypoglycemia appears spontaneously. We wish this to be considered merely as a tentative etiologic framework, for an entirely adequate