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Optimizing the management of hypoglycaemia in individuals with type 2 diabetes: A randomized crossover comparison of a weight‐based protocol compared with two fixed‐dose glucose regimens
Author(s) -
Krebs Jeremy D.,
Weatherall Mark,
Corley Brian,
Wiltshire Esko,
McTavish Lindsay
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13231
Subject(s) - medicine , crossover study , hypoglycemia , type 2 diabetes , diabetes mellitus , randomized controlled trial , weight loss , odds ratio , gastroenterology , endocrinology , obesity , placebo , alternative medicine , pathology
Aims To determine whether an individualized body weight‐based glucose treatment in adults with type 2 diabetes (T2DM) is more likely to resolve hypoglycaemia with a single treatment without excessive rebound hyperglycaemia compared to fixed doses of 12 or 30 g of glucose. Methods Adults with T2DM were enrolled in a cross‐over study. Each episode of hypoglycaemia (capillary glucose <4.0 mmol/L) was randomly assigned to 1 of 3 treatment protocols: 0.3 g glucose/kg body‐weight or a fixed dose of either 12 or 30 g glucose, independent of weight. All participants received each treatment in random order for up to 15 hypoglycaemic episodes. Glucose was re‐tested 10 minutes after treatment, with a repeat dose if still <4 mmol/L. Results Mean (SD) age of the 30 participants was 68 (8.1) years, mean weight was 91.5 (16.8) kg and mean HbA1c was 58.7 (9.2) mmol/mol. Among a total of 244 episodes of hypoglycaemia, 10 participants had 15 treatment episodes and 18 participants had fewer than 10 treatment episodes. The odds ratio, adjusted for multiple comparisons, for resolution of hypoglycaemia at 10 minutes, comparing weight‐based treatment and 12 g treatment was 3.2 (95% CI, 1.1–9.0), P = .009, comparing 30 g treatment and 12 g treatment was 8.9 (95% CI, 2.2–36.6), P < .001, and comparing weight‐based treatment and 30 g treatment was 0.36 (95% CI, 0.08–1.67) P = .10. Conclusion In T2DM, both a weight‐based 0.3 g/kg treatment and a fixed 30 g glucose treatment result in higher blood glucose than a 12 g treatment, along with increased probability of resolution of hypoglycaemia after 10 minutes. Both treatments result in an excess of mild rebound hyperglycaemia (>8 mmol/L) at 30 minutes.