Early Loss of the Glucagon Response to Hypoglycemia in Adolescents With Type 1

Diabetes

Featured Article:

Aris Siafarikas, F.R.A.C.P., M.D., Robert J. Johnston, M.R.C.P., Max K. Bulsara, Ph.D., Peter O’Leary, Ph.D., Timothy W. Jones, M.B.B.S., F.R.A.C.P., M.D., Elizabeth A. Davis, M.B.B.S., F.R.A.C.P., Ph.D.

Diabetes Care Volume 35: 1757-1762

August, 2012

Study Objective

• To assess the glucagon response to hypoglycemia and identify influencing factors in patients with type 1 diabetes compared with nondiabetic control subjects

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Study Design

• Hyperinsulinemic hypoglycemic clamp studies performed in 28 adolescents with type 1 diabetes and 12 healthy control participants

• Measured:• Glucagon response to both hypoglycemia and arginine• Epinephrine, cortisol, and growth hormone responses to

hypoglycemia• Residual β-cell function using fasting and stimulated C-

peptide

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Results• Type 1 diabetes participants: 50% female, mean age 14.9 years

(range 11.2–19.8), Median duration of type 1 diabetes 0.66 years (range 0.01–9.9)

 • Healthy control subjects: 50% female, mean age 15.3 years (12.8–

18.7) • Glucagon peak to arginine stimulation was similar between groups

(P = 0.27)

• Glucagon peak to hypoglycemia was • Reduced in the group with diabetes (95%CI): 68 (62–74)

vs. 96 (87–115) pg/mL (P < 0.001)• 3 SDs from baseline for 7% of subjects with type 1

diabetes vs. 83% of controls• Lost at median duration of diabetes of 8 months and as

early as 1 month after diagnosis (R =20.41, P < 0.01). • Not correlated with height, weight, BMI, and HbA1c

 • Epinephrine, cortisol, and growth hormone responses to

hypoglycemia were present in both groups

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Siafarikas A et al. Diabetes Care 2012;35:1757-1762

Conclusions

• The glucagon response to hypoglycemia in adolescents with type 1 diabetes is influenced by the duration of diabetes and can be lost early in the course of the disease

Siafarikas A et al. Diabetes Care 2012;35:1757-1762