Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes

T1D Exchange Mini-dose Glucagon Study Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Context: Standard treatment of hypoglycemia is oral carbohydrate, but it often results in hyperglycemia and entails extra caloric intake. Objective: To evaluate low-dose glucagon to treat mild hypoglycemia in ambulatory adults with type 1 diabetes (T1D). Design: Randomized crossover trial (two 3-week periods). Setting: Five U.S. diabetes clinics. Patients: Twenty adults with T1D using an insulin pump and continuous glucose monitor (CGM) and experiencing frequent mild hypoglycemia. Intervention: Nonaqueous mini-dose glucagon (MDG) (150 μg) to treat nonsevere hypoglycemia. Main Outcome Measures: Successful treatment was defined as blood glucose (BG) ≥50 mg/dL 15 minutes and ≥70mg/dL 30 minutes after intervention, on the studymeter. Two authors, blinded to treatment arm, independently judged each event as a clinical success or failure. Results: Sixteen participants (mean age 39 years, 75% female, mean diabetes duration 23 years, mean hemoglobin A1c 7.2%) had 118 analyzable events with initial BG of 50 to 69 mg/dL. Successful treatment criteria were met for 58 (94%) of 62 events during the MDG period and 53 (95%) of 56 events during the glucose tablets (TABS) period (adjusted P = 0.99). Clinical assessments of success for these events were 97% and 96%, respectively. CGM-measured time in range did not differ between treatment groups during the 2 hours after events, but TABS resulted in higher maximum glucose (116 vs 102 mg/dL; P = 0.01) over the first hour. Conclusions: Low-dose glucagon can successfully treat mild hypoglycemia and may be a useful alternative to treatment with oral carbohydrate when trying to avoid unnecessary caloric intake.

Original languageEnglish (US)
Pages (from-to)2994-3001
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number8
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Medical problems
Glucagon
Type 1 Diabetes Mellitus
Hypoglycemia
Safety
Glucose
Tablets
Blood Glucose
Carbohydrates
Energy Intake
Therapeutics
Hemoglobins
Pumps
Insulin
Hyperglycemia
Cross-Over Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes. / T1D Exchange Mini-dose Glucagon Study Group.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 102, No. 8, 01.08.2017, p. 2994-3001.

Research output: Contribution to journalArticle

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title = "Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes",
abstract = "Context: Standard treatment of hypoglycemia is oral carbohydrate, but it often results in hyperglycemia and entails extra caloric intake. Objective: To evaluate low-dose glucagon to treat mild hypoglycemia in ambulatory adults with type 1 diabetes (T1D). Design: Randomized crossover trial (two 3-week periods). Setting: Five U.S. diabetes clinics. Patients: Twenty adults with T1D using an insulin pump and continuous glucose monitor (CGM) and experiencing frequent mild hypoglycemia. Intervention: Nonaqueous mini-dose glucagon (MDG) (150 μg) to treat nonsevere hypoglycemia. Main Outcome Measures: Successful treatment was defined as blood glucose (BG) ≥50 mg/dL 15 minutes and ≥70mg/dL 30 minutes after intervention, on the studymeter. Two authors, blinded to treatment arm, independently judged each event as a clinical success or failure. Results: Sixteen participants (mean age 39 years, 75{\%} female, mean diabetes duration 23 years, mean hemoglobin A1c 7.2{\%}) had 118 analyzable events with initial BG of 50 to 69 mg/dL. Successful treatment criteria were met for 58 (94{\%}) of 62 events during the MDG period and 53 (95{\%}) of 56 events during the glucose tablets (TABS) period (adjusted P = 0.99). Clinical assessments of success for these events were 97{\%} and 96{\%}, respectively. CGM-measured time in range did not differ between treatment groups during the 2 hours after events, but TABS resulted in higher maximum glucose (116 vs 102 mg/dL; P = 0.01) over the first hour. Conclusions: Low-dose glucagon can successfully treat mild hypoglycemia and may be a useful alternative to treatment with oral carbohydrate when trying to avoid unnecessary caloric intake.",
author = "{T1D Exchange Mini-dose Glucagon Study Group} and Haymond, {Morey W.} and DuBose, {Stephanie N.} and Rickels, {Michael R.} and Howard Wolpert and Shah, {Viral N.} and Sherr, {Jennifer L.} and Weinstock, {Ruth S.} and Shivani Agarwal and Verdejo, {Alandra S.} and Cummins, {Martin J.} and Brett Newswanger and Beck, {Roy W.} and Sarit Polsky and Christie Beatson and Scott Brackett and Elena Toschi and Stephanie Edwards and Castillo, {Astrid Atakov} and Suzan Bzdick and Eileen Tichy and Melinda Zgorski and Amy Steffen and Eileen Markman and Cornelia Dalton-Bakes and Amy Peleckis and Steve Prestrelski and Poul Strange",
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T1 - Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes

AU - T1D Exchange Mini-dose Glucagon Study Group

AU - Haymond, Morey W.

AU - DuBose, Stephanie N.

AU - Rickels, Michael R.

AU - Wolpert, Howard

AU - Shah, Viral N.

AU - Sherr, Jennifer L.

AU - Weinstock, Ruth S.

AU - Agarwal, Shivani

AU - Verdejo, Alandra S.

AU - Cummins, Martin J.

AU - Newswanger, Brett

AU - Beck, Roy W.

AU - Polsky, Sarit

AU - Beatson, Christie

AU - Brackett, Scott

AU - Toschi, Elena

AU - Edwards, Stephanie

AU - Castillo, Astrid Atakov

AU - Bzdick, Suzan

AU - Tichy, Eileen

AU - Zgorski, Melinda

AU - Steffen, Amy

AU - Markman, Eileen

AU - Dalton-Bakes, Cornelia

AU - Peleckis, Amy

AU - Prestrelski, Steve

AU - Strange, Poul

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Context: Standard treatment of hypoglycemia is oral carbohydrate, but it often results in hyperglycemia and entails extra caloric intake. Objective: To evaluate low-dose glucagon to treat mild hypoglycemia in ambulatory adults with type 1 diabetes (T1D). Design: Randomized crossover trial (two 3-week periods). Setting: Five U.S. diabetes clinics. Patients: Twenty adults with T1D using an insulin pump and continuous glucose monitor (CGM) and experiencing frequent mild hypoglycemia. Intervention: Nonaqueous mini-dose glucagon (MDG) (150 μg) to treat nonsevere hypoglycemia. Main Outcome Measures: Successful treatment was defined as blood glucose (BG) ≥50 mg/dL 15 minutes and ≥70mg/dL 30 minutes after intervention, on the studymeter. Two authors, blinded to treatment arm, independently judged each event as a clinical success or failure. Results: Sixteen participants (mean age 39 years, 75% female, mean diabetes duration 23 years, mean hemoglobin A1c 7.2%) had 118 analyzable events with initial BG of 50 to 69 mg/dL. Successful treatment criteria were met for 58 (94%) of 62 events during the MDG period and 53 (95%) of 56 events during the glucose tablets (TABS) period (adjusted P = 0.99). Clinical assessments of success for these events were 97% and 96%, respectively. CGM-measured time in range did not differ between treatment groups during the 2 hours after events, but TABS resulted in higher maximum glucose (116 vs 102 mg/dL; P = 0.01) over the first hour. Conclusions: Low-dose glucagon can successfully treat mild hypoglycemia and may be a useful alternative to treatment with oral carbohydrate when trying to avoid unnecessary caloric intake.

AB - Context: Standard treatment of hypoglycemia is oral carbohydrate, but it often results in hyperglycemia and entails extra caloric intake. Objective: To evaluate low-dose glucagon to treat mild hypoglycemia in ambulatory adults with type 1 diabetes (T1D). Design: Randomized crossover trial (two 3-week periods). Setting: Five U.S. diabetes clinics. Patients: Twenty adults with T1D using an insulin pump and continuous glucose monitor (CGM) and experiencing frequent mild hypoglycemia. Intervention: Nonaqueous mini-dose glucagon (MDG) (150 μg) to treat nonsevere hypoglycemia. Main Outcome Measures: Successful treatment was defined as blood glucose (BG) ≥50 mg/dL 15 minutes and ≥70mg/dL 30 minutes after intervention, on the studymeter. Two authors, blinded to treatment arm, independently judged each event as a clinical success or failure. Results: Sixteen participants (mean age 39 years, 75% female, mean diabetes duration 23 years, mean hemoglobin A1c 7.2%) had 118 analyzable events with initial BG of 50 to 69 mg/dL. Successful treatment criteria were met for 58 (94%) of 62 events during the MDG period and 53 (95%) of 56 events during the glucose tablets (TABS) period (adjusted P = 0.99). Clinical assessments of success for these events were 97% and 96%, respectively. CGM-measured time in range did not differ between treatment groups during the 2 hours after events, but TABS resulted in higher maximum glucose (116 vs 102 mg/dL; P = 0.01) over the first hour. Conclusions: Low-dose glucagon can successfully treat mild hypoglycemia and may be a useful alternative to treatment with oral carbohydrate when trying to avoid unnecessary caloric intake.

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