Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.
Identifieur interne : 002C34 ( PubMed/Checkpoint ); précédent : 002C33; suivant : 002C35Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.
Auteurs : Pratik Choudhary [Royaume-Uni] ; Michael R. Rickels [États-Unis] ; Peter A. Senior [Canada] ; Marie-Christine Vantyghem [France] ; Paola Maffi [Italie] ; Thomas W. Kay [Australie] ; Bart Keymeulen [Belgique] ; Nobuya Inagaki [Japon] ; Frantisek Saudek [République tchèque] ; Roger Lehmann [Suisse] ; Bernhard J. Hering [États-Unis]Source :
- Diabetes care [ 1935-5548 ] ; 2015.
Descripteurs français
- KwdFr :
- Algorithmes, Autosurveillance glycémique, Conscience immédiate, Diabète de type 1 (), Glycémie (métabolisme), Humains, Hypoglycémiants (usage thérapeutique), Hypoglycémie (), Insuline (usage thérapeutique), Médecine factuelle, Pompes à insuline, Transplantation pancréatique, Éducation du patient comme sujet ().
- MESH :
- métabolisme : Glycémie.
- usage thérapeutique : Hypoglycémiants, Insuline.
- Algorithmes, Autosurveillance glycémique, Conscience immédiate, Diabète de type 1, Humains, Hypoglycémie, Médecine factuelle, Pompes à insuline, Transplantation pancréatique, Éducation du patient comme sujet.
English descriptors
- KwdEn :
- Algorithms, Awareness, Blood Glucose (metabolism), Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1 (prevention & control), Evidence-Based Medicine, Humans, Hypoglycemia (prevention & control), Hypoglycemic Agents (therapeutic use), Insulin (therapeutic use), Insulin Infusion Systems, Pancreas Transplantation, Patient Education as Topic (methods).
- MESH :
- chemical , metabolism : Blood Glucose.
- methods : Patient Education as Topic.
- prevention & control : Diabetes Mellitus, Type 1, Hypoglycemia.
- chemical , therapeutic use : Hypoglycemic Agents, Insulin.
- Algorithms, Awareness, Blood Glucose Self-Monitoring, Evidence-Based Medicine, Humans, Insulin Infusion Systems, Pancreas Transplantation.
Abstract
Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.
DOI: 10.2337/dc15-0090
PubMed: 25998294
Affiliations:
- Australie, Belgique, Canada, France, Italie, Japon, Royaume-Uni, République tchèque, Suisse, États-Unis
- Angleterre, Bohême centrale, Canton de Zurich, Grand Londres, Lombardie, Pennsylvanie, Région de Bruxelles-Capitale, Région du Kansai, Victoria (État)
- Bruxelles, Kyoto, Londres, Melbourne, Milan, Prague, Zurich
- Université de Kyoto, Université de Melbourne, Université de Zurich
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pubmed:25998294Le document en format XML
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<front><div type="abstract" xml:lang="en">Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.</div>
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<ELocationID EIdType="doi" ValidYN="Y">10.2337/dc15-0090</ELocationID>
<Abstract><AbstractText>Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.</AbstractText>
<CopyrightInformation>© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Choudhary</LastName>
<ForeName>Pratik</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Diabetes Research Group, King's College London, London, U.K.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Rickels</LastName>
<ForeName>Michael R</ForeName>
<Initials>MR</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Senior</LastName>
<ForeName>Peter A</ForeName>
<Initials>PA</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vantyghem</LastName>
<ForeName>Marie-Christine</ForeName>
<Initials>MC</Initials>
<AffiliationInfo><Affiliation>Endocrinology and Metabolism Department, INSERM U1190, European Genomics Institute for Diabetes, Lille University Hospital, Lille Cedex, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Maffi</LastName>
<ForeName>Paola</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Diabetes Research Institute, Scientific Institute Ospedale San Raffaele, Milan, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kay</LastName>
<ForeName>Thomas W</ForeName>
<Initials>TW</Initials>
<AffiliationInfo><Affiliation>Immunology and Diabetes Unit, St. Vincent's Institute, University of Melbourne, Melbourne, Australia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Keymeulen</LastName>
<ForeName>Bart</ForeName>
<Initials>B</Initials>
<AffiliationInfo><Affiliation>Diabetes Clinic and Research Center, Vrije Universiteit Brussel, Brussels, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Inagaki</LastName>
<ForeName>Nobuya</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Department of Diabetes and Clinical Nutrition, Kyoto University, Kyoto, Japan.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Saudek</LastName>
<ForeName>Frantisek</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lehmann</LastName>
<ForeName>Roger</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Department of Endocrinology and Diabetology, University of Zurich, Zurich, Switzerland.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hering</LastName>
<ForeName>Bernhard J</ForeName>
<Initials>BJ</Initials>
<AffiliationInfo><Affiliation>Schulze Diabetes Institute and Department of Surgery, University of Minnesota, Minneapolis, MN bhering@umn.edu.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<GrantList CompleteYN="Y"><Grant><GrantID>U01-AI-065193</GrantID>
<Acronym>AI</Acronym>
<Agency>NIAID NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>R01-DK-091331</GrantID>
<Acronym>DK</Acronym>
<Agency>NIDDK NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>U01 AI102463</GrantID>
<Acronym>AI</Acronym>
<Agency>NIAID NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>U01-AI-102463</GrantID>
<Acronym>AI</Acronym>
<Agency>NIAID NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>U01 AI065193</GrantID>
<Acronym>AI</Acronym>
<Agency>NIAID NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>R01 DK091331</GrantID>
<Acronym>DK</Acronym>
<Agency>NIDDK NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>U01-DK-070430</GrantID>
<Acronym>DK</Acronym>
<Agency>NIDDK NIH HHS</Agency>
<Country>United States</Country>
</Grant>
<Grant><GrantID>U01 DK070430</GrantID>
<Acronym>DK</Acronym>
<Agency>NIDDK NIH HHS</Agency>
<Country>United States</Country>
</Grant>
</GrantList>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType>
<PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType>
<PublicationType UI="D016454">Review</PublicationType>
</PublicationTypeList>
</Article>
<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>Diabetes Care</MedlineTA>
<NlmUniqueID>7805975</NlmUniqueID>
<ISSNLinking>0149-5992</ISSNLinking>
</MedlineJournalInfo>
<ChemicalList><Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D001786">Blood Glucose</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D007004">Hypoglycemic Agents</NameOfSubstance>
</Chemical>
<Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D007328">Insulin</NameOfSubstance>
</Chemical>
</ChemicalList>
<CitationSubset>IM</CitationSubset>
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