AustralieFrV1, PubMed, Checkpoint, bibRecord, 002C34

Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

Identifieur interne : 002C34 ( PubMed/Checkpoint ); précédent : 002C33; suivant : 002C35

Evidence-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.

RBID : pubmed:25998294

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:

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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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<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>
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<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Choudhary</LastName>
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<Initials>P</Initials>
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<Author ValidYN="Y"><LastName>Rickels</LastName>
<ForeName>Michael R</ForeName>
<Initials>MR</Initials>
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<Author ValidYN="Y"><LastName>Senior</LastName>
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<Initials>PA</Initials>
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<Author ValidYN="Y"><LastName>Vantyghem</LastName>
<ForeName>Marie-Christine</ForeName>
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<Initials>P</Initials>
<AffiliationInfo><Affiliation>Diabetes Research Institute, Scientific Institute Ospedale San Raffaele, Milan, Italy.</Affiliation>
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<Author ValidYN="Y"><LastName>Kay</LastName>
<ForeName>Thomas W</ForeName>
<Initials>TW</Initials>
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<Initials>B</Initials>
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<Initials>N</Initials>
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</Author>
<Author ValidYN="Y"><LastName>Saudek</LastName>
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<Initials>F</Initials>
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<Author ValidYN="Y"><LastName>Lehmann</LastName>
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<Initials>R</Initials>
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<ForeName>Bernhard J</ForeName>
<Initials>BJ</Initials>
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</AffiliationInfo>
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<MeshHeading><DescriptorName UI="D007003" MajorTopicYN="N">Hypoglycemia</DescriptorName>
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<MeshHeading><DescriptorName UI="D007328" MajorTopicYN="N">Insulin</DescriptorName>
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<MeshHeading><DescriptorName UI="D007332" MajorTopicYN="N">Insulin Infusion Systems</DescriptorName>
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<MeshHeading><DescriptorName UI="D016035" MajorTopicYN="N">Pancreas Transplantation</DescriptorName>
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<PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2015</Year>
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<PubMedPubDate PubStatus="pubmed"><Year>2015</Year>
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<PubMedPubDate PubStatus="medline"><Year>2015</Year>
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<li>Zurich</li>
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<orgName><li>Université de Kyoto</li>
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</country>
<country name="Australie"><region name="Victoria (État)"><name sortKey="Kay, Thomas W" sort="Kay, Thomas W" uniqKey="Kay T" first="Thomas W" last="Kay">Thomas W. Kay</name>
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<country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Keymeulen, Bart" sort="Keymeulen, Bart" uniqKey="Keymeulen B" first="Bart" last="Keymeulen">Bart Keymeulen</name>
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<country name="Japon"><region name="Région du Kansai"><name sortKey="Inagaki, Nobuya" sort="Inagaki, Nobuya" uniqKey="Inagaki N" first="Nobuya" last="Inagaki">Nobuya Inagaki</name>
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<country name="République tchèque"><region name="Bohême centrale"><name sortKey="Saudek, Frantisek" sort="Saudek, Frantisek" uniqKey="Saudek F" first="Frantisek" last="Saudek">Frantisek Saudek</name>
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</country>
<country name="Suisse"><region name="Canton de Zurich"><name sortKey="Lehmann, Roger" sort="Lehmann, Roger" uniqKey="Lehmann R" first="Roger" last="Lehmann">Roger Lehmann</name>
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   |area=    AustralieFrV1
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   |type=    RBID
   |clé=     pubmed:25998294
   |texte=   Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.
}}

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	Serveur d'exploration sur les relations entre la France et l'Australie
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Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

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