Highlights and New Studies on Hypoglycemia in Type 1 Diabetes from the 2019 EASD Annual Meeting

Each year, the European Association for the Study of Diabetes (EASD) presents the results of the latest diabetes research at its Annual Meeting. The last such event was held from September 16 to 20, 2019. Here are some of the hypoglycemia-related highlights:

Severe hypoglycemia (episodes that result in a loss of consciousness or need another person’s intervention to be treated) increase the risk of death

Researchers from Graz, Austria and Swansea, Wales conducted a study from 2000 to 2018 on 8,626 people living with type 1 diabetes. Their results showed that suffering from severe hypoglycemia repeatedly can affect one’s risk of death.

This risk had already been observed in people living with type 2 diabetes. But the same observations held true in this type 1-specific study despite participants’ younger average age of 31. The increase in mortality risk is very slight, but it is measurable.

It’s impossible to know whether episodes of severe hypoglycemia occur more frequently in people who are sicker, or whether the severe hypoglycemia is directly linked with the higher risk of death.

This study highlights even more reasons, beyond the traumatic nature of severe hypoglycemic episodes, for developing new approaches to reduce the frequency of such events—and this is the main purpose of the BETTER project.

C-peptide and its effect on hypoglycemia

The C-peptide measured in a blood test is used to assess the amount of insulin your pancreas is able to produce. For a long time, medical science assumed that people living with type 1 diabetes no longer produced any insulin and therefore no C-peptide either. However, recent research has shown that some people still produce a bit of insulin and small amounts of C-peptide.

A study conducted by the University of Edinburgh compared the frequency of hypoglycemic episodes (measured by continuous glucose monitoring device) and the level of C-peptide in people living with type 1 diabetes. The results show that people who still produce some insulin are less prone to hypoglycemia than those who no longer produce any at all.

This finding may be explained by the fact that the pancreatic cells that produce glucagon are right next to the ones that secrete insulin and possibly healthier when the latter are still slightly active.

A lot of research is still being done to identify people with type 1 diabetes who still produce a bit of insulin and to understand the mechanism by which some pancreatic cells survive.

High-intensity activity and its effect on hypoglycemia unawareness 

Some people who live with type 1 diabetes no longer experience symptoms during hypoglycemic episodes. This puts them at higher risk of severe hypoglycemia (in which they lose consciousness or need another person’s intervention) since they are no longer able to recognize, and thus treat, hypoglycemia. It’s estimated that 20 to 25% of people living with type 1 diabetes have difficulty feeling symptoms of hypoglycemia

Researchers at the University of Dundee examined the potential of high-intensity physical activity to increase counterregulatory response to hypoglycemia (along with the associated symptoms). The experiments involved 12 people who no longer feel symptoms of hyperglycemia performing a series of intense sprints on a bike. The researchers then assessed whether symptoms were present during a hypoglycemic episode. Interestingly enough, they found that people started showing symptoms of hypoglycemia again after the workout.

These findings will need to be validated with a larger study, but they do suggest possible avenues for improving hypoglycemia awareness.

These studies pave the way for future solutions and serve as reminders of the importance of preventing hypoglycemic episodes as much as possible in people living with type 1 diabetes.

Help us advance research by registering in the BETTER registry.

References :

  • Moser, O., Rafferty, J., Eckstein, M.L., McCarthy, O., Bracken, R.M., Sourij, H., Bain, S.C., Thomas, R.L. (2019). Number of Preceding Episodes of Severe Hypoglycaemia Determine Subsequent Acute Death in People with Type 1 Diabetes: A Retrospective Cohort Study. Abstract 87. 55th EASD Annual Meeting. 
  • Gibb, F.W., McKnight, J.A., Clarke, C., Strachan, M.W.J. (2019). C-Peptide Micro-Secretion is Associated with Lower Rates of Hypoglycaemia on Flash Glucose Monitoring in People with Type 1 Diabetes. Abstract 85. 55th EASD Annual Meeting. 
  • Improved Counter Regulatory Response to Hypoglycaemia After Dishabituation with High Intensity Exercise in People with Type 1 Diabetes and Impaired Hypoglycaemia Awareness. (2019). Abstract 89. 55th EASD Annual Meeting.

picture taken from : https://www.easd.org/annual-meeting/easd-2019.html

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