This review focuses on rat models for studying the short-term and long-term effects of mild and severe hypoglycemia.We explored the physiological mechanisms to understand the consequences of hypoglycemia in rat experi...This review focuses on rat models for studying the short-term and long-term effects of mild and severe hypoglycemia.We explored the physiological mechanisms to understand the consequences of hypoglycemia in rat experimental models.This study aims to investigate the therapeutic potential of phytotherapeutic agents and their efficacy in mitigating the adverse effects of hypoglycemia.Insights from our planned research will be beneficial in improving quality of life for individuals at risk of episodes of low blood sugar.Optimizing hypoglycemic rat models for research requires selecting a suitable experimental model that will be susceptible to hypoglycemia induction,effective monitoring of blood glucose levels,and maintaining a high survival rate throughout the required experimental duration.展开更多
BACKGROUND Insulin is the preferred clinical treatment for hospitalized patients with type 2 diabetes mellitus(T2DM)to control blood glucose effectively.Hypoglycemia is one of the most common adverse events.Accurate p...BACKGROUND Insulin is the preferred clinical treatment for hospitalized patients with type 2 diabetes mellitus(T2DM)to control blood glucose effectively.Hypoglycemia is one of the most common adverse events.Accurate prediction of the risk of hypoglycemia is critical in reducing hypoglycemic events and related adverse events in hospitalized diabetic patients treated with insulin.AIM To develop and validate a hypoglycemia risk prediction tool for hospitalized patients with T2DM treated with insulin.METHODS This retrospective study included 802 hospitalized patients with T2DM in the Department of Endocrinology,the Third Affiliated Hospital of Sun Yat-sen University,between January 2021 and December 2021.The hypoglycemia risk prediction model was developed using logistic regression and nomogram models.The model was validated and calibrated using receiver operating characteristic curves and the Hosmer-Lemeshow goodness of fit test.RESULTS The incidence of hypoglycemia among the enrolled patients was 44.9%.The hypoglycemic risk prediction model included six predictors:Body mass index,duration of diabetes,history of hypoglycemia within 1 year,glomerular filtration rate,blood triglyceride levels,and duration of treatment.The hypoglycemia risk prediction model displayed high discrimination ability(area under the curve=0.67)and good calibration power(goodness of fit,χ^(2)=12.25,P=0.14).CONCLUSION The hypoglycemia risk prediction model for hospitalized patients with T2DM on insulin therapy displayed high reliability and discrimination ability.The model is a promising tool for clinicians to screen hospitalized patients with T2DM and an elevated risk of hypoglycemia and guide personalized interventions to prevent and treat hypoglycemia.展开更多
Studies have shown that the implementation of targeted nursing countermeasures can significantly reduce the incidence of hypoglycemia in inpatients with diabetes mellitus,improve patients’quality of life,and promote ...Studies have shown that the implementation of targeted nursing countermeasures can significantly reduce the incidence of hypoglycemia in inpatients with diabetes mellitus,improve patients’quality of life,and promote the stable control of their condition.This paper conducts an in-depth analysis on the influencing factors of hypoglycemia in inpatients with diabetes mellitus and the corresponding nursing countermeasures.It expounds the main factors affecting hypoglycemia in inpatients with diabetes mellitus,and then puts forward effective nursing countermeasures.The purpose is to provide valuable references for promoting the innovative development of clinical nursing work.展开更多
This letter comments on a study by Jin et al,published recently in the World Journal of Diabetes.Hypoglycemia is a significant complication of diabetes,with primary defense mechanisms involving the stimulation of gluc...This letter comments on a study by Jin et al,published recently in the World Journal of Diabetes.Hypoglycemia is a significant complication of diabetes,with primary defense mechanisms involving the stimulation of glucagon secretion inα-cells and the inhibition of insulin secretion in pancreaticβ-cells,which are often compromised in type 1 diabetes mellitus(T1DM)and advanced type 2 diabetes mellitus.Recurrent hypoglycemia predisposes the development of impaired hypoglycemia awareness,a condition underpinned by complex pathophysiological processes,encompassing central nervous system adaptations and several hormonal interactions,including a potential role for glucagon-like peptide-1(GLP-1)in paracrine and endocrine vias.Experimental evidence indicates that GLP-1 may impair hypoglycemic counterregulation by disrupting the sympathoadrenal system and promoting somatostatin release in pancreaticδ-cells,which inhibits glucagon secretion from neighboringα-cells.However,current trials evaluating GLP-1 receptor agonists(GLP-1 RAs)in T1DM patients have shown promising benefits in reducing insulin requirements and body weight,without increasing the risk of hypoglycemia.Further research is essential to elucidate the specific roles of GLP-1 and GLP-1 RAs in modulating glucagon secretion and the sympathetic-adrenal reflex,and their impact on hypoglycemia unawareness in T1DM patients.展开更多
Recent advances in understanding type 1 diabetes(T1D)highlight the complexity of managing hypoglycemia,a frequent and perilous complication of diabetes therapy.This letter delves into a novel study by Jin et al,which ...Recent advances in understanding type 1 diabetes(T1D)highlight the complexity of managing hypoglycemia,a frequent and perilous complication of diabetes therapy.This letter delves into a novel study by Jin et al,which elucidates the role of intestinal glucagon-like peptide-1(GLP-1)in the counterregulatory response to hypoglycemia in T1D models.The study employed immunofluorescence,Western blotting,and enzyme-linked immunosorbent assay to track changes in GLP-1 and its receptor expression in diabetic mice subjected to recurrent hypoglycemic episodes.Findings indicate a significant increase in intestinal GLP-1 and GLP-1 receptor expression,correlating with diminished adrenal and glucagon responses,crucial for glucose stabilization during hypoglycemic events.This letter aims to explore the implications of these findings for future therapeutic strategies and the broader understanding of T1D management.展开更多
Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus(T1DM).Fear of hypoglycemia(FoH)is a significant psychosocial consequence that negatively impacts the willingness of T1DM patien...Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus(T1DM).Fear of hypoglycemia(FoH)is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity(e.g.,cardiometabolic health,improved body composition,cardiovascular fitness,quality of life).Technological advances,improved insulin regimens,and a better understanding of the physiology of various types of exercise could help ameliorate FoH.This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.展开更多
BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of N...BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of NICTH that was observed 30 years before the onset of hypoglycemia.CASE SUMMARY A 50-year-old man was diagnosed with an abnormal right chest shadow during a routine X-ray examination,but no further examination was undertaken because the lesion appeared benign.Thirty years after the tumor discovery,the patient was admitted to the hospital with symptoms of severe hypoglycemia,which was diagnosed as NICTH based on a complete examination.The tumor was resected and found to be a solitary fibrous mass(15.6 cm×13.7 cm×10.4 cm);thereafter,the patient’s blood glucose levels normalized and he completely recovered.CONCLUSION NICTH can have an acute onset,even if the tumor has been present and asymptomatic over a long time period.展开更多
Postbariatric hypoglycemia is a rare but increasingly recognized complication of bariatric surgery,with significant associated morbidity,and many patients often require multimodal treatment.A mixed meal challenge test...Postbariatric hypoglycemia is a rare but increasingly recognized complication of bariatric surgery,with significant associated morbidity,and many patients often require multimodal treatment.A mixed meal challenge test is often helpful to diagnose this condition.This manuscript highlights the underlying mechanisms that lead to this condition and the novel emerging therapeutic targets that target these mechanisms.展开更多
Objective:To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.Methods:The prospective obse...Objective:To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.Methods:The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric.196 Newborn babies with blood glucose levels<45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021.Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.Results:The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher(23.4%vs.8.4%)(P<0.05).Small for gestational age,low birth weight,respiratory distress syndrome,hypothermia,and endocrine disorders were risk factors.The death rate in asymptomatic hypoglycemia neonates was significantly higher(58%vs.39%)(P<0.05).Conclusions:The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality.It is important to take vigilance and timely interventions to address associated symptoms,particularly poor feeding,in the management of neonatal hypoglycemia.展开更多
Hypoglycemia unawareness(HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms.It is a major limitation to achieving tight diabetes and reduced quality of life.HU occurs in...Hypoglycemia unawareness(HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms.It is a major limitation to achieving tight diabetes and reduced quality of life.HU occurs in approximately 40% of people with type 1 diabetesmellitus(T1DM) and with less frequency in T2 DM.Though the aetiology of HU is multifactorial,possible mechanisms include chronic exposure to low blood glucose,antecedent hypoglycaemia,recurrent severe hypoglycaemia and the failure of counter-regulatory hormones.Clinically it manifests as the inability to recognise impeding hypoglycaemia by symptoms,but the mechanisms and mediators remain largely unknown.Prevention and management of HU is complex,and can only be achieved by a multifactorial intervention of clinical care and structured patient education by the diabetes team.Less know regarding the impact of medications on the development or recognition of this condition in patients with diabetes.Several medications are thought to worsen or promote HU,whereas others may have an attenuating effect on the problem.This article reviews recent advances in how the brain senses and responds to hypoglycaemia,novel mechanisms by which people with insulin-treated diabetes develop HU and impaired counter-regulatory responses.The consequences that HU has on the person with diabetes and their family are also described.Finally,it examines the evidence for prevention and treatment of HU,and summarizes the effects of medications that may influence it.展开更多
The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus（DM） patients with episodes of recurrent severe hypoglycemia, by using meta-analysis to synthes...The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus（DM） patients with episodes of recurrent severe hypoglycemia, by using meta-analysis to synthesize data across studies. PubMed, EMBASE and Cochrane library search engines were used to identify studies on cognitive performance in DM patients with recurrent severe hypoglycemia.Random-effects meta-analysis was performed on seven eligible studies using an inverse-variance method. Effect sizes, which are the standardized differences between the experimental group and the control group, were calculated. Of the 853 studies, 7 studies met the inclusion criteria. Compared with control subjects, the adult DM patients with episodes of recurrent severe hypoglycemia demonstrated a significantly lowered performance on memory in both types of DM patients, and poor performance of processing speed in type 2 DM patients. There was no significant difference between adult DM patients with and those without severe hypoglycemia in other cognitive domains such as general intelligence,executive function, processing speed and psychomotor efficiency. Our results seem to confirm the hypothesis that cognitive dysfunction is characterized by worse memory and processing speed in adult DM patients with a history of recurrent severe hypoglycemia, whereas general intelligence, executive function,and psychomotor efficiency are spared.展开更多
A 4-month-old male baby who presented in a moribund condition with seizures was found to have hepatomegaly,hypoglycemia and milky serum.Serum triglycerides were markedly elevated(3168 mg/dL) with cholesterol being 257...A 4-month-old male baby who presented in a moribund condition with seizures was found to have hepatomegaly,hypoglycemia and milky serum.Serum triglycerides were markedly elevated(3168 mg/dL) with cholesterol being 257 mg/dL and high density lipoprotein levels were low(19 mg/dL).The possibility of glycogen storage disease type Ⅰ was considered in the diagnosis.Infants with glycogen storage disease type Ⅰ may present like sepsis.The association of hepatomegaly, hypoglycemia and abnormal lipid profile stated above should alert the physician to consider glycogen storage disease type Ⅰ in the diagnosis.展开更多
Hypoglycemia is a common complication in patients with diabetes,mainly in those treated with insulin,sulfonylurea,or glinide.Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main ...Hypoglycemia is a common complication in patients with diabetes,mainly in those treated with insulin,sulfonylurea,or glinide.Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia.Episodes of hypoglycemia are associated with physical and psychological morbidity.The fear of hypoglycemia constitutes a barrier that impairs the patient’s ability to reach good glycemic control.To prevent hypoglycemia,much effort must be invested in patient education regarding risk factors,warning signs,and treatment of hypoglycemia at an early stage,together with setting personalized goals for glycemic control.In this review,we present a comprehensive update on the treatment and prevention of hypoglycemia in type 1 and type 2 diabetic patients.展开更多
AIM To measure the incidence and determinants(predictors) of hypoglycemia among patients with type 2 diabetes mellitus(T2DM) who were on insulin treatment for at least one year. METHODS The present study is an out-pat...AIM To measure the incidence and determinants(predictors) of hypoglycemia among patients with type 2 diabetes mellitus(T2DM) who were on insulin treatment for at least one year. METHODS The present study is an out-patients based inquiry about the risk and predictors of hypoglycemia among patients with T2DM seeking care at the Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center, in Basrah over a period of 7 mo(from 15^(th) of April, 2013 to 15^(th) of October, 2013). The data used in the study were based on all detailed interview and selected laboratory investigations. A total of 336 patients could be included in the study.RESULTS The incidence of overall hypoglycemia among the studied patients was 75.3% within the last 3 mo preceding the interview. The incidence of hypoglycemia subtypes were 10.2% for severe hypoglycemia requiring medical assistance in the hospital, 44.36% for severe hypoglycemia treated at home by family; this includes both confirmed severe hypoglycemia with an incidence rate of 14.6% and unconfirmed severe hypoglycemia for which incidence rate was 29.76%. Regarding mild self-treated hypoglycemia, the incidence of confirmed mild hypoglycemia was 21.42%, for unconfirmed mildhypoglycemia the incidence rate was 50.0% and for total mild hypoglycemia, the incidence rate was 71.42%. The most important predictors of hypoglycemia were a peripheral residence, increasing knowledge of hypoglycemia symptoms, in availability and increasing frequency of self-monitoring blood glucose, the presence of peripheral neuropathy, higher diastolic blood pressure, and lower Hemoglobin A1c.CONCLUSION Hypoglycemia is very common among insulin-treated patients with T2DM in Basrah. It was possible to identify some important predictors of hypoglycemia.展开更多
Recent clinical trials indicated that the intensive glycemic control do not reduce cardiovascular disease mortality among diabetic patients, challenging a significance of the strict glycemic control in diabetes manage...Recent clinical trials indicated that the intensive glycemic control do not reduce cardiovascular disease mortality among diabetic patients, challenging a significance of the strict glycemic control in diabetes management. Furthermore, retrospective analysis of the Action to Control Cardiovascular Risk in Diabetes study demonstrated a significant association betweenhypoglycemia and mortality. Here, we systematically reviewed the drug-induced hypoglycemia, and also the underlying clinical factors for hypoglycemia in patients with diabetes. The sulfonylurea use is significantly associated with severe hypoglycemia in patients with type 2 diabetes. The use of biguanide(approximately 45%-76%) and thiazolidinediones(approximately 15%-34%) are also highly associated with the development of severe hypoglycemia. In patients treated with insulin, the intensified insulin therapy is more frequently associated with severe hypoglycemia than the conventional insulin therapy and continuous subcutaneous insulin infusion. Among the underlying clinical factors for development of severe hypoglycemia, low socioeconomic status, aging, longer duration of diabetes, high Hb A1 c and low body mass index, comorbidities are precipitating factors for severe hypoglycemia. Poor cognitive and mental functions are also associated with severe hypoglycemia.展开更多
BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor ...BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.展开更多
Objective To evaluate the effects of acute glucose level changes on expression of prepro-orexin, orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R) mRNA in rat hypothalamus tissue and pancreatic islets cells. Metho...Objective To evaluate the effects of acute glucose level changes on expression of prepro-orexin, orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R) mRNA in rat hypothalamus tissue and pancreatic islets cells. Methods Thirty adult male Wistar rats were randomly divided into three equal groups (n = 10). The acute hypoglycemia rat model was induced by a single subcutaneous injection of insulin. Twenty acute hypoglycemia rats were divided into group B and group C. Group B was allowed to eat freely, while group C was food-deprived. Control rats were injected the same volume of saline. The effect of glucose levels (2.8 mmol/L and 8.3 mmol/L) on pancreatic islet cell orexin system was detected in pancreas islet cell cultured in vitro. The expression of prepro-orexin and OXR mRNA was examined in rat hypothalamus tissue and pancreatic islets cell cultured in vitro using reverse transcription-polymerase chain reaction (RT-PCR). Results Expression of orexin mRNA increased about 150% for the food-deprived hypoglycemia rats in comparison with control group (P < 0.01), whereas expression of OX1R mRNA decreased up to 30% (P < 0.01). However, expression of OX2R mRNA was unchanged in comparison with control group. In vitro, after incubation with 2.8 mmol/L glucose for 6 hours, the expression of prepro-orexin mRNA increased 2 times in rat pancreas islet cells in comparison with 8.3 mmol/L glucose group (P < 0.01). But the expression of OX1R mRNA was not sensitive to acute glucose fluctuation.Conclusions Orexin in rat hypothalamus is stimulated by decline in blood glucose and inhibited by signals related to feeding. Moreover, glucose plays a role in modulating the gene expression of prepro-orexin in rat pancreatic islet cells.展开更多
The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose lev...The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.展开更多
BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown s...BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.展开更多
Objective:This study aimed to evaluate the reliability and validity of the Chinese version of the Fear of Hypoglycemia scale with 15 items(FH-15).Methods:After obtaining the original author's authorization,the Eng...Objective:This study aimed to evaluate the reliability and validity of the Chinese version of the Fear of Hypoglycemia scale with 15 items(FH-15).Methods:After obtaining the original author's authorization,the English version of the FH-15 scale was translated,back translated,and culturally debugged to obtain the Chinese version of FH-15.A convenient sampling method was used to extract patients with type 2 diabetes from four tertiary hospitals in Tianjin.A total of 408 patients with type 2 diabetes were investigated in the hospital to test the reliability and validity of Chinese version FH-15 scale.Results:The content validity index of the scale was 0.92,and the content validity index of each item was 0.8-1.0.The exploratory factor analysis extracted three common factors(fear,avoidance,and interference),which contained 15 items,and the cumulative variance contribution rate was 71.245%.The confirmatory factor analysis results showed that the model fit was better at 1.981 x2/df,GFI=0.901,CGI=0.962,TLI=0.952,and RMSEA=0.070.The cut-off value for the total hypoglycemia fear scale was 30.5.The Cronbach'sαcoefficient of the three dimensions of the scale was 0.918,the Cronbach'sαcoefficient of each dimension is 0.876-0.916,the test-retest reliability was 0.903,and the test-retest reliability of each factor was 0.733-0.930.Conclusion:The Chinese version of the FH-15 scale can be considered reliable and valid.The item expression is concise,clear,and easy to understand.It is suitable for clinical practice as an initial screening tool to identify and evaluate the severity of fear of hypoglycemia in patients with type 2 diabetes.展开更多
基金Correspondence:Christina Gertrude Yap,Jeffrey Cheah School of Medicine and Health Sciences,Monash University,Jalan Lagoon Selatan,Bandar Sunway,Subang Jaya 47500,Selangor,Malaysia.Email:christina.yap@monash.edu。
文摘This review focuses on rat models for studying the short-term and long-term effects of mild and severe hypoglycemia.We explored the physiological mechanisms to understand the consequences of hypoglycemia in rat experimental models.This study aims to investigate the therapeutic potential of phytotherapeutic agents and their efficacy in mitigating the adverse effects of hypoglycemia.Insights from our planned research will be beneficial in improving quality of life for individuals at risk of episodes of low blood sugar.Optimizing hypoglycemic rat models for research requires selecting a suitable experimental model that will be susceptible to hypoglycemia induction,effective monitoring of blood glucose levels,and maintaining a high survival rate throughout the required experimental duration.
基金Supported by Medical Scientific Research Foundation of Guangdong Province of China,No.A2023183 and No.A2024530Nursing Innovation Development Research Project,No.YJYZ202304+2 种基金National Natural Science Foundation of China,No.72204277Guangdong Basic and Applied Basic Research Foundation,No.2025A15150127063rd Affiliated Hospital of Sun Yat-sen University,Clinical Research Program,No.YHJH202404.
文摘BACKGROUND Insulin is the preferred clinical treatment for hospitalized patients with type 2 diabetes mellitus(T2DM)to control blood glucose effectively.Hypoglycemia is one of the most common adverse events.Accurate prediction of the risk of hypoglycemia is critical in reducing hypoglycemic events and related adverse events in hospitalized diabetic patients treated with insulin.AIM To develop and validate a hypoglycemia risk prediction tool for hospitalized patients with T2DM treated with insulin.METHODS This retrospective study included 802 hospitalized patients with T2DM in the Department of Endocrinology,the Third Affiliated Hospital of Sun Yat-sen University,between January 2021 and December 2021.The hypoglycemia risk prediction model was developed using logistic regression and nomogram models.The model was validated and calibrated using receiver operating characteristic curves and the Hosmer-Lemeshow goodness of fit test.RESULTS The incidence of hypoglycemia among the enrolled patients was 44.9%.The hypoglycemic risk prediction model included six predictors:Body mass index,duration of diabetes,history of hypoglycemia within 1 year,glomerular filtration rate,blood triglyceride levels,and duration of treatment.The hypoglycemia risk prediction model displayed high discrimination ability(area under the curve=0.67)and good calibration power(goodness of fit,χ^(2)=12.25,P=0.14).CONCLUSION The hypoglycemia risk prediction model for hospitalized patients with T2DM on insulin therapy displayed high reliability and discrimination ability.The model is a promising tool for clinicians to screen hospitalized patients with T2DM and an elevated risk of hypoglycemia and guide personalized interventions to prevent and treat hypoglycemia.
文摘Studies have shown that the implementation of targeted nursing countermeasures can significantly reduce the incidence of hypoglycemia in inpatients with diabetes mellitus,improve patients’quality of life,and promote the stable control of their condition.This paper conducts an in-depth analysis on the influencing factors of hypoglycemia in inpatients with diabetes mellitus and the corresponding nursing countermeasures.It expounds the main factors affecting hypoglycemia in inpatients with diabetes mellitus,and then puts forward effective nursing countermeasures.The purpose is to provide valuable references for promoting the innovative development of clinical nursing work.
基金Industrial Technological Initiation Scholarship of National Council for Scientific and Technological Development,CNPq,No.0932204294929829CNPq Research Productivity Fellow,No.4357511882624145.
文摘This letter comments on a study by Jin et al,published recently in the World Journal of Diabetes.Hypoglycemia is a significant complication of diabetes,with primary defense mechanisms involving the stimulation of glucagon secretion inα-cells and the inhibition of insulin secretion in pancreaticβ-cells,which are often compromised in type 1 diabetes mellitus(T1DM)and advanced type 2 diabetes mellitus.Recurrent hypoglycemia predisposes the development of impaired hypoglycemia awareness,a condition underpinned by complex pathophysiological processes,encompassing central nervous system adaptations and several hormonal interactions,including a potential role for glucagon-like peptide-1(GLP-1)in paracrine and endocrine vias.Experimental evidence indicates that GLP-1 may impair hypoglycemic counterregulation by disrupting the sympathoadrenal system and promoting somatostatin release in pancreaticδ-cells,which inhibits glucagon secretion from neighboringα-cells.However,current trials evaluating GLP-1 receptor agonists(GLP-1 RAs)in T1DM patients have shown promising benefits in reducing insulin requirements and body weight,without increasing the risk of hypoglycemia.Further research is essential to elucidate the specific roles of GLP-1 and GLP-1 RAs in modulating glucagon secretion and the sympathetic-adrenal reflex,and their impact on hypoglycemia unawareness in T1DM patients.
文摘Recent advances in understanding type 1 diabetes(T1D)highlight the complexity of managing hypoglycemia,a frequent and perilous complication of diabetes therapy.This letter delves into a novel study by Jin et al,which elucidates the role of intestinal glucagon-like peptide-1(GLP-1)in the counterregulatory response to hypoglycemia in T1D models.The study employed immunofluorescence,Western blotting,and enzyme-linked immunosorbent assay to track changes in GLP-1 and its receptor expression in diabetic mice subjected to recurrent hypoglycemic episodes.Findings indicate a significant increase in intestinal GLP-1 and GLP-1 receptor expression,correlating with diminished adrenal and glucagon responses,crucial for glucose stabilization during hypoglycemic events.This letter aims to explore the implications of these findings for future therapeutic strategies and the broader understanding of T1D management.
文摘Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus(T1DM).Fear of hypoglycemia(FoH)is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity(e.g.,cardiometabolic health,improved body composition,cardiovascular fitness,quality of life).Technological advances,improved insulin regimens,and a better understanding of the physiology of various types of exercise could help ameliorate FoH.This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.
文摘BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia(NICTH).As NICTH is a rare lesion,the natural course of NICTH is not well understood.We report a case of NICTH that was observed 30 years before the onset of hypoglycemia.CASE SUMMARY A 50-year-old man was diagnosed with an abnormal right chest shadow during a routine X-ray examination,but no further examination was undertaken because the lesion appeared benign.Thirty years after the tumor discovery,the patient was admitted to the hospital with symptoms of severe hypoglycemia,which was diagnosed as NICTH based on a complete examination.The tumor was resected and found to be a solitary fibrous mass(15.6 cm×13.7 cm×10.4 cm);thereafter,the patient’s blood glucose levels normalized and he completely recovered.CONCLUSION NICTH can have an acute onset,even if the tumor has been present and asymptomatic over a long time period.
文摘Postbariatric hypoglycemia is a rare but increasingly recognized complication of bariatric surgery,with significant associated morbidity,and many patients often require multimodal treatment.A mixed meal challenge test is often helpful to diagnose this condition.This manuscript highlights the underlying mechanisms that lead to this condition and the novel emerging therapeutic targets that target these mechanisms.
文摘Objective:To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.Methods:The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric.196 Newborn babies with blood glucose levels<45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021.Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.Results:The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher(23.4%vs.8.4%)(P<0.05).Small for gestational age,low birth weight,respiratory distress syndrome,hypothermia,and endocrine disorders were risk factors.The death rate in asymptomatic hypoglycemia neonates was significantly higher(58%vs.39%)(P<0.05).Conclusions:The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality.It is important to take vigilance and timely interventions to address associated symptoms,particularly poor feeding,in the management of neonatal hypoglycemia.
文摘Hypoglycemia unawareness(HU) is defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms.It is a major limitation to achieving tight diabetes and reduced quality of life.HU occurs in approximately 40% of people with type 1 diabetesmellitus(T1DM) and with less frequency in T2 DM.Though the aetiology of HU is multifactorial,possible mechanisms include chronic exposure to low blood glucose,antecedent hypoglycaemia,recurrent severe hypoglycaemia and the failure of counter-regulatory hormones.Clinically it manifests as the inability to recognise impeding hypoglycaemia by symptoms,but the mechanisms and mediators remain largely unknown.Prevention and management of HU is complex,and can only be achieved by a multifactorial intervention of clinical care and structured patient education by the diabetes team.Less know regarding the impact of medications on the development or recognition of this condition in patients with diabetes.Several medications are thought to worsen or promote HU,whereas others may have an attenuating effect on the problem.This article reviews recent advances in how the brain senses and responds to hypoglycaemia,novel mechanisms by which people with insulin-treated diabetes develop HU and impaired counter-regulatory responses.The consequences that HU has on the person with diabetes and their family are also described.Finally,it examines the evidence for prevention and treatment of HU,and summarizes the effects of medications that may influence it.
基金supported by grants from the Natural Science Foundation of Hubei Province(No.2016CFB671)China Postdoctoral Science Foundation(No.2016M590696)
文摘The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus（DM） patients with episodes of recurrent severe hypoglycemia, by using meta-analysis to synthesize data across studies. PubMed, EMBASE and Cochrane library search engines were used to identify studies on cognitive performance in DM patients with recurrent severe hypoglycemia.Random-effects meta-analysis was performed on seven eligible studies using an inverse-variance method. Effect sizes, which are the standardized differences between the experimental group and the control group, were calculated. Of the 853 studies, 7 studies met the inclusion criteria. Compared with control subjects, the adult DM patients with episodes of recurrent severe hypoglycemia demonstrated a significantly lowered performance on memory in both types of DM patients, and poor performance of processing speed in type 2 DM patients. There was no significant difference between adult DM patients with and those without severe hypoglycemia in other cognitive domains such as general intelligence,executive function, processing speed and psychomotor efficiency. Our results seem to confirm the hypothesis that cognitive dysfunction is characterized by worse memory and processing speed in adult DM patients with a history of recurrent severe hypoglycemia, whereas general intelligence, executive function,and psychomotor efficiency are spared.
基金financially supported by Kasturba Medical College,Manipal,Manipal University
文摘A 4-month-old male baby who presented in a moribund condition with seizures was found to have hepatomegaly,hypoglycemia and milky serum.Serum triglycerides were markedly elevated(3168 mg/dL) with cholesterol being 257 mg/dL and high density lipoprotein levels were low(19 mg/dL).The possibility of glycogen storage disease type Ⅰ was considered in the diagnosis.Infants with glycogen storage disease type Ⅰ may present like sepsis.The association of hepatomegaly, hypoglycemia and abnormal lipid profile stated above should alert the physician to consider glycogen storage disease type Ⅰ in the diagnosis.
文摘Hypoglycemia is a common complication in patients with diabetes,mainly in those treated with insulin,sulfonylurea,or glinide.Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia.Episodes of hypoglycemia are associated with physical and psychological morbidity.The fear of hypoglycemia constitutes a barrier that impairs the patient’s ability to reach good glycemic control.To prevent hypoglycemia,much effort must be invested in patient education regarding risk factors,warning signs,and treatment of hypoglycemia at an early stage,together with setting personalized goals for glycemic control.In this review,we present a comprehensive update on the treatment and prevention of hypoglycemia in type 1 and type 2 diabetic patients.
文摘AIM To measure the incidence and determinants(predictors) of hypoglycemia among patients with type 2 diabetes mellitus(T2DM) who were on insulin treatment for at least one year. METHODS The present study is an out-patients based inquiry about the risk and predictors of hypoglycemia among patients with T2DM seeking care at the Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center, in Basrah over a period of 7 mo(from 15^(th) of April, 2013 to 15^(th) of October, 2013). The data used in the study were based on all detailed interview and selected laboratory investigations. A total of 336 patients could be included in the study.RESULTS The incidence of overall hypoglycemia among the studied patients was 75.3% within the last 3 mo preceding the interview. The incidence of hypoglycemia subtypes were 10.2% for severe hypoglycemia requiring medical assistance in the hospital, 44.36% for severe hypoglycemia treated at home by family; this includes both confirmed severe hypoglycemia with an incidence rate of 14.6% and unconfirmed severe hypoglycemia for which incidence rate was 29.76%. Regarding mild self-treated hypoglycemia, the incidence of confirmed mild hypoglycemia was 21.42%, for unconfirmed mildhypoglycemia the incidence rate was 50.0% and for total mild hypoglycemia, the incidence rate was 71.42%. The most important predictors of hypoglycemia were a peripheral residence, increasing knowledge of hypoglycemia symptoms, in availability and increasing frequency of self-monitoring blood glucose, the presence of peripheral neuropathy, higher diastolic blood pressure, and lower Hemoglobin A1c.CONCLUSION Hypoglycemia is very common among insulin-treated patients with T2DM in Basrah. It was possible to identify some important predictors of hypoglycemia.
基金Supported by A grant from the National Center for Global Health and Medicine(25-203)
文摘Recent clinical trials indicated that the intensive glycemic control do not reduce cardiovascular disease mortality among diabetic patients, challenging a significance of the strict glycemic control in diabetes management. Furthermore, retrospective analysis of the Action to Control Cardiovascular Risk in Diabetes study demonstrated a significant association betweenhypoglycemia and mortality. Here, we systematically reviewed the drug-induced hypoglycemia, and also the underlying clinical factors for hypoglycemia in patients with diabetes. The sulfonylurea use is significantly associated with severe hypoglycemia in patients with type 2 diabetes. The use of biguanide(approximately 45%-76%) and thiazolidinediones(approximately 15%-34%) are also highly associated with the development of severe hypoglycemia. In patients treated with insulin, the intensified insulin therapy is more frequently associated with severe hypoglycemia than the conventional insulin therapy and continuous subcutaneous insulin infusion. Among the underlying clinical factors for development of severe hypoglycemia, low socioeconomic status, aging, longer duration of diabetes, high Hb A1 c and low body mass index, comorbidities are precipitating factors for severe hypoglycemia. Poor cognitive and mental functions are also associated with severe hypoglycemia.
文摘BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.
基金Supported by Important FinancialIssueof Shi-Wu Programming Key Problem in Liaoning Provinceand Financial Issue for Scientific Research in the Department of Education.
文摘Objective To evaluate the effects of acute glucose level changes on expression of prepro-orexin, orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R) mRNA in rat hypothalamus tissue and pancreatic islets cells. Methods Thirty adult male Wistar rats were randomly divided into three equal groups (n = 10). The acute hypoglycemia rat model was induced by a single subcutaneous injection of insulin. Twenty acute hypoglycemia rats were divided into group B and group C. Group B was allowed to eat freely, while group C was food-deprived. Control rats were injected the same volume of saline. The effect of glucose levels (2.8 mmol/L and 8.3 mmol/L) on pancreatic islet cell orexin system was detected in pancreas islet cell cultured in vitro. The expression of prepro-orexin and OXR mRNA was examined in rat hypothalamus tissue and pancreatic islets cell cultured in vitro using reverse transcription-polymerase chain reaction (RT-PCR). Results Expression of orexin mRNA increased about 150% for the food-deprived hypoglycemia rats in comparison with control group (P < 0.01), whereas expression of OX1R mRNA decreased up to 30% (P < 0.01). However, expression of OX2R mRNA was unchanged in comparison with control group. In vitro, after incubation with 2.8 mmol/L glucose for 6 hours, the expression of prepro-orexin mRNA increased 2 times in rat pancreas islet cells in comparison with 8.3 mmol/L glucose group (P < 0.01). But the expression of OX1R mRNA was not sensitive to acute glucose fluctuation.Conclusions Orexin in rat hypothalamus is stimulated by decline in blood glucose and inhibited by signals related to feeding. Moreover, glucose plays a role in modulating the gene expression of prepro-orexin in rat pancreatic islet cells.
基金National Natural Science Foundation of China(No. 81370932)to LZthe Program for Professor of Special Appointment(Eastern Scholar)at Shanghai Institutions of Higher Learning(2009) to LZ+3 种基金the Pujiang Talent Project (PJ2011-0000839) of Shanghai Science and Technology to LZthe Merck Sharp&Dohme Corporation(IISP MISP40313 and MISP40309) to LZTalents Training Program of Shanghai Pudong Hospital to LZproject of Shanghai University of Traditional Chinese Medicine to LZ
文摘The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.
文摘BACKGROUND Cardiovascular outcome trials have demonstrated cardiovascular safety of glimepiride(a sulfonylureas) against dipeptidyl peptidase-4 inhibitor linagliptin.Gliclazide(another newer sulfonylureas) has shown similar glycemic efficacy and 50% decreased risk of hypoglycemia compared to glimepiride.AIM Considering the absence of cardiovascular outcome trials for gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular(CV) safety by assessing the risk for major adverse CV events and hypoglycemia risk of gliclazide vs linagliptin in patients with type 2 diabetes(T2D).METHODS This systematic review followed the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to analyze all the clinical studies published from 2008 that compared the two drugs in patients with T2D with no risk of CV disease(CVD). We included only evidence designated high quality by the Oxford Center for Evidence-based Medicine-Levels of Evidence.RESULTS Eight clinical studies were included in the narrative descriptive analysis(gliclazide: 5 and linagliptin: 3). The CV safety of gliclazide in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial and of linagliptin in the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin(CARMELINA) and CARdiovascular Outcome study of LINAgliptin vs glimepiride in patients with T2D(CAROLINA)trials were excluded from the comparative analysis as these trials demonstrated CV and hypoglycemia benefits in patients at high risk of CVD. However, since these are landmark trials,they were discussed in brief to show the CV benefits and low hypoglycemia risk of gliclazide and linagliptin. We did not find any study comparing gliclazide with linagliptin. Hence, direct comparison of their major adverse CV events and hypoglycemia risk could not be carried out.However, the literature meeting the inclusion criteria showed that both drugs were effective in achieving the desired glycemic control and had low major adverse CV events and hypoglycemia risk in adult patients with no history of CVD.CONCLUSION Gliclazide can be considered an effective and safe glucose-lowering drug in T2D patients with no established CVD but at high risk of CVD due to their T2D status. Future randomized controlled trials comparing gliclazide with linagliptin or dipeptidyl peptidase-4 inhibitors can confirm these findings.
文摘Objective:This study aimed to evaluate the reliability and validity of the Chinese version of the Fear of Hypoglycemia scale with 15 items(FH-15).Methods:After obtaining the original author's authorization,the English version of the FH-15 scale was translated,back translated,and culturally debugged to obtain the Chinese version of FH-15.A convenient sampling method was used to extract patients with type 2 diabetes from four tertiary hospitals in Tianjin.A total of 408 patients with type 2 diabetes were investigated in the hospital to test the reliability and validity of Chinese version FH-15 scale.Results:The content validity index of the scale was 0.92,and the content validity index of each item was 0.8-1.0.The exploratory factor analysis extracted three common factors(fear,avoidance,and interference),which contained 15 items,and the cumulative variance contribution rate was 71.245%.The confirmatory factor analysis results showed that the model fit was better at 1.981 x2/df,GFI=0.901,CGI=0.962,TLI=0.952,and RMSEA=0.070.The cut-off value for the total hypoglycemia fear scale was 30.5.The Cronbach'sαcoefficient of the three dimensions of the scale was 0.918,the Cronbach'sαcoefficient of each dimension is 0.876-0.916,the test-retest reliability was 0.903,and the test-retest reliability of each factor was 0.733-0.930.Conclusion:The Chinese version of the FH-15 scale can be considered reliable and valid.The item expression is concise,clear,and easy to understand.It is suitable for clinical practice as an initial screening tool to identify and evaluate the severity of fear of hypoglycemia in patients with type 2 diabetes.
