Hypoglycemia
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Claims the paper makes
28 of 93 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Frequency and severity of hypoglycemia negatively impact quality of life in people with diabetes.
“Frequency and severity of hypoglycemia negatively impact on quality of life (1) and promote fear of future hypoglycemia (2,3).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [1] 1. Alvarez-Guisasola F, Yin DD, Nocea G, et al. Association of hypoglycemic symptoms with patients' rating of their health-related quality of life state: A cross sectional study. Health Qual Life Outcomes 2010;8:86. source
The Abstract Results and Discussion report worse quality-of-life ratings among patients with hypoglycemic symptoms, with larger decrements at greater symptom severity. The study assessed whether patients had experienced symptoms in the prior year, not how frequently episodes occurred; it also studied patients with type 2 diabetes receiving oral treatment, rather than people with diabetes generally. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
Fear of future hypoglycemia is associated with reduced self-care and poor glucose control.
“This fear is associated with reduced self-care and poor glucose control (4)(5)(6).”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [4] 4. Barnard K, Thomas S, Royle P, et al. Fear of hypoglycaemia in parents of young children with type 1 diabetes: A systematic review. BMC Pediatr 2010;10:50. source
The Results (Hypoglycaemic avoidance behaviour) link parental fear-related avoidance behaviours with higher blood glucose in young children. But the Conclusion says further research is needed to determine whether fear leads to poorer glycaemic control, and the copy does not establish reduced self-care; it describes behaviours such as frequent monitoring instead. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [5] 5. Di Battista AM, Hart TA, Greco L, et al. Type 1 diabetes among adolescents: Reduced diabetes self-care caused by social fear and fear of hypoglycemia. Dia- betes Educ 2009;35:465-75. source
- cites [6] 6. Haugstvedt A, Wentzel-Larsen T, Graue M, et al. Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: A population-based study. Diabet Med 2010;27:72-8. source
- Premisecitation
Strict avoidance of hypoglycemia for a period of 2 days to 3 months is associated with improvement in recognition of severe hypoglycemia, counterregulatory hormone responses, or both.
“Strict avoidance of hypoglycemia for a period of 2 days to 3 months has been associated with improvement in the recognition of severe hypoglycemia, the counterregulatory hormone responses or both (32)(33)(34)(35)(36)(37)(38)(39).”
Quote in the paperSubstantial claim2 of 8 sources checked- cites [32] 32. Ovalle F, Fanelli CG, Paramore DS, et al. Brief twice-weekly episodes of hypo- glycemia reduce detection of clinical hypoglycemia in type 1 diabetes melli- tus. Diabetes 1998;47:1472-9. source
- cites [33] 33. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglyce- mia normalizes the glycemic thresholds and magnitude of most of neuroen- docrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Diabetes 1993;42:1683- 9. source
- cites [34] 34. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unaware- ness, but not defective glucose counterregulation, in IDDM. Diabetes 1994;43:1426-34. source
- cites [35] 35. Fanelli C, Pampanelli S, Epifano L, et al. Long-term recovery from unaware- ness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Diabetologia 1994;37:1265-76. source
The Abstract and Experimental group results report improved counterregulatory hormone and symptom responses after meticulous prevention of hypoglycaemia, beginning at 2 weeks and continuing through 3 months. This paper does not report improvement after 2 days or directly measure recognition of severe hypoglycaemic episodes; the Results say no severe episodes occurred during follow-up. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [36] 36. Dagogo-Jack S, Fanelli CG, Cryer PE. Durable reversal of hypoglycemia unawareness in type 1 diabetes. Diabetes Care 1999;22:866-7. source
- cites [37] 37. Davis M, Mellman M, Friedman S, et al. Recovery of epinephrine response but not hypoglycemic symptom threshold after intensive therapy in type 1 diabetes. Am J Med 1994;97:535-42. source
- cites [38] 38. Liu D, McManus RM, Ryan EA. Improved counter-regulatory hormonal and symp- tomatic responses to hypoglycemia in patients with insulin-dependent diabe- tes mellitus after 3 months of less strict glycemic control. Clin Invest Med 1996;19:71-82.
- cites [39] 39. Lingenfelser T, Buettner U, Martin J, et al. Improvement of impaired counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM. Diabetes Care 1995;18:321-5. source
- Premisecitation
Recurrent hypoglycemia may impair the individual's ability to sense subsequent hypoglycemia.
“Recurrent hypoglycemia may impair the individual's ability to sense subsequent hypoglycemia (54,55).”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [54] 54. Davis SN, Mann S, Briscoe VJ, et al. Effects of intensive therapy and antecedent hypoglycemia on counterregulatory responses to hypoglycemia in type 2 dia- betes. Diabetes 2009;58:701-9. source
- cites [55] 55. Diabetes Research in Children Network (DirecNet) Study Group, Tsalikian E, Tamborlane W, et al. Blunted counterregulatory hormone responses to hypo- glycemia in young children and adolescents with well-controlled type 1 dia- betes. Diabetes Care 2009;32:1954-9. source
The Conclusions (page unavailable) report that antecedent hypoglycemia impairs hormonal responses to subsequent hypoglycemia. The Results (page unavailable) also document poor recognition of low glucose in young children. The study does not establish that recurrent hypoglycemia caused an individual to become less able to sense later episodes; it measured responses and symptom recognition during a single test. (LLM, conf=0.81)
Experimental — accuracy not yet measured
- Premisecitation
Lowered cognitive performance appears to be more associated with the presence of microvascular complications or poor metabolic control than with the occurrence of severe hypoglycemic episodes.
“Lowered cognitive performance appears to be more associated with the presence of microvascular complications or poor metabolic control than with the occurrence of severe hypoglycemic episodes (57,61).”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [57] 57. Zhang Z, Lovato J, Battapady H, et al. Effect of hypoglycemia on brain structure in people with type 2 diabetes: Epidemiological analysis of the ACCORD- MIND MRI trial. Diabetes Care 2014;37:3279-85. source
The Conclusions (page unavailable) report no additional brain atrophy or abnormal white matter after severe symptomatic hypoglycemia in treated people with type 2 diabetes, which offers indirect support for the hypoglycemia part of the claim. But the paper measures brain structure, not cognitive performance, and does not establish that microvascular complications or poor metabolic control are more strongly associated with lowered cognitive performance. It explicitly cautions that its MRI measures reflect structure, not function. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [61] 61. Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: A meta-analysis. Diabetes Care 2005;28:726- 35. source
- Interpretationcitation
Severe hypoglycemia may also be a marker of vulnerability, without any direct causal contribution to the increased mortality.
“However, severe hypoglycemia may also be a marker of vulnerability, without any direct causal contribution to the increased mortality (72).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [72] 72. Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the pre- vention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA diabetes trials: A position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care 2009;32:187-92. source
- Premisecitation
Hypoglycemia promotes fear of future hypoglycemia.
“Frequency and severity of hypoglycemia negatively impact on quality of life (1) and promote fear of future hypoglycemia (2,3).”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Severe hypoglycemia resulting in seizures is more likely to occur at night than during the day.
“Severe hypoglycemia, resulting in seizures, is more likely to occur at night than during the day (12).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] 12. Davis EA, Keating B, Byrne GC, et al. Hypoglycemia: Incidence and clinical pre- dictors in a large population-based sample of children and adolescents with IDDM. Diabetes Care 1997;20:22-5. source
- Premisecitation
Severe hypoglycemia is often the primary barrier to achieving glycemic targets in people with type 1 diabetes.
“Severe hypoglycemia is often the primary barrier to achieving glycemic targets in people with type 1 diabetes (24) and occurs frequently during sleep or in the presence of hypoglycemia unawareness (11,25).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] 24. Cryer PE. Banting lecture. Hypoglycemia: The limiting factor in the manage- ment of IDDM. Diabetes 1994;43:1378-89. source
- Premisecitation
Severe hypoglycemia occurs frequently during sleep or in the presence of hypoglycemia unawareness in people with type 1 diabetes.
“Severe hypoglycemia is often the primary barrier to achieving glycemic targets in people with type 1 diabetes (24) and occurs frequently during sleep or in the presence of hypoglycemia unawareness (11,25).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [11] 11. The DCCT Research Group. Epidemiology of severe hypoglycemia in the diabe- tes control and complications trial. Am J Med 1991;90:450-9. source
- cites [25] 25. Daneman D, Frank M, Perlman K, et al. Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors. J Pediatr 1989;115:681-5. source
- Premisecitation
Evidence suggests that 15 g glucose (monosaccharide) is required to produce an increase in blood glucose of approximately 2.1 mmol/L within 20 minutes, with adequate symptom relief for most people.
“Evidence suggests that 15 g glucose (monosaccharide) is required to produce an increase in BG of approximately 2.1 mmol/L within 20 minutes, with adequate symptom relief for most people (Table 4) (73)(74)(75)(76)(77).”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [73] 73. Slama G, Traynard PY, Desplanque N, et al. The search for an optimized treatment of hypoglycemia. carbohydrates in tablets, solutin, or gel for the correction of insulin reactions. Arch Intern Med 1990;150:589-93. source
- cites [74] 74. Wiethop BV, Cryer PE. Alanine and terbutaline in treatment of hypoglycemia in IDDM. Diabetes Care 1993;16:1131-6. source
- cites [75] 75. Brodows RG, Williams C, Amatruda JM. Treatment of insulin reactions in dia- betics. JAMA 1984;252:3378-81. source
- cites [76] 76. Skyler JS (Ed.): Medical Management of Type 1 Diabetes. 3rd ed. Alexandria, VA, American Diabetes Association, 1998. pg. 134-43.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [77] 77. Canadian Diabetes Association. The role of dietary sugars in diabetes mellitus. Beta Release 1991;15:117-23.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Glucagon 1 mg given subcutaneously or intramuscularly produces a significant increase in blood glucose (from 3.0 to 12.0 mmol/L) within 60 minutes.
“Glucagon 1 mg given subcutaneously or intramuscularly produces a significant increase in BG (from 3.0 to 12.0 mmol/L) within 60 minutes (80).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [80] 80. Cryer PE, Fisher JN, Shamoon H. Hypoglycemia. Diabetes Care 1994;17:734- 55. source
- Premisecitation
A 20 g oral glucose dose will produce a blood glucose increment of approximately 3.6 mmol/L at 45 minutes.
“A 20 g oral glucose dose will produce a BG increment of approximately 3.6 mmol/L at 45 minutes (74,75).”
Quote in the paperNot a substantial claim0 of 2 sources checked
- May combine two claims. 16
- Classified as probably not a substantial claim. 2
May combine two claims.
PremisecitationAsymptomatic nocturnal hypoglycemia is common and often lasts greater than 4 hours.
“Asymptomatic nocturnal hypoglycemia is common and often lasts greater than 4 hours (11,(28)(29)(30)(31).”
Quote in the paperNot a substantial claim1 of 5 sources checked- cites [11] 11. The DCCT Research Group. Epidemiology of severe hypoglycemia in the diabe- tes control and complications trial. Am J Med 1991;90:450-9. source
- cites [28] 28. Porter PA, Byrne G, Stick S, et al. Nocturnal hypoglycaemia and sleep distur- bances in young teenagers with insulin dependent diabetes mellitus. Arch Dis Child 1996;75:120-3. source
The Discussion describes nocturnal hypoglycaemia as common and usually asymptomatic in adolescents with insulin-dependent diabetes; the Abstract reports that five of six affected subjects had no symptoms. The duration passage reports 3.96 hours on average (range 1–7 hours), but does not establish that episodes often lasted more than four hours. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [29] 29. Gale EA, Tattersall RB. Unrecognised nocturnal hypoglycaemia in insulin- treated diabetics. Lancet 1979;1:1049-52. source
- cites [30] 30. Beregszàszi M, Tubiana-Rufi N, Benali K, et al. Nocturnal hypoglycemia in chil- dren and adolescents with insulin-dependent diabetes mellitus: Prevalence and risk factors. J Pediatr 1997;131:27-33. source
- cites [31] 31. Vervoort G, Goldschmidt HM, van Doorn LG. Nocturnal blood glucose profiles in patients with type 1 diabetes mellitus on multiple (> or = 4) daily insulin injec- tion regimens. Diabet Med 1996;13:794-9. source
May combine two claims.
PremisecitationThe sympathoadrenal response to hypoglycemia is reduced during sleep, and following exercise or alcohol consumption.
“The sympathoadrenal response to hypoglycemia is reduced during sleep, and following exercise or alcohol consumption (26,27).”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [26] 26. Berlin I, Sachon CI, Grimaldi A. Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes melli- tus. Diabetes Metab 2005;31:246-51. source
- cites [27] 27. Schultes B, Jauch-Chara K, Gais S, et al. Defective awakening response to noc- turnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med 2007;4:e69. source
The Introduction (page unavailable) reports impaired counterregulation against hypoglycemia during sleep and a delayed response threshold during sleep in healthy adults. The paper does not address reduced sympathoadrenal responses following exercise or alcohol consumption. (LLM, conf=0.87)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationProspective studies have not found an association between intensive insulin therapy and cognitive function, or between severe hypoglycemia and future cognitive function.
“Prospective studies have not found an association between intensive insulin therapy and cognitive function (58)(59)(60), or between severe hypoglycemia and future cognitive function (56,57).”
Quote in the paperSubstantial claim2 of 5 sources checked- cites [58] 58. The Diabetes Control and Complications Trial Research Group. Effects of inten- sive diabetes therapy on neuropsychological function in adults in the Diabetes Control and Complications Trial. Ann Intern Med 1996;124:379-88. source
- cites [59] 59. Reichard P, Pihl M. Mortality and treatment side-effects during long-term inten- sified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Diabetes 1994;43:313-17. source
- cites [60] 60. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interven- tions and Complications Study Research Group, Jacobson AM, Musen G, et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med 2007;356:1842-52. source
- cites [56] 56. Bruce DG, Davis WA, Casey GP, et al. Severe hypoglycaemia and cognitive impair- ment in older patients with diabetes: The Fremantle Diabetes Study. Diabetologia 2009;52:1808-15. source
- cites [57] 57. Zhang Z, Lovato J, Battapady H, et al. Effect of hypoglycemia on brain structure in people with type 2 diabetes: Epidemiological analysis of the ACCORD- MIND MRI trial. Diabetes Care 2014;37:3279-85. source
The Introduction (page not provided) reports that the DCCT found no significant correlation between treatment-related hypoglycemic events and neuropsychological function. But this paper’s own prospective analysis measured brain structure, not future cognitive function; the Conclusions explicitly caution that its MRI variables reflect structure, not function. It therefore does not establish the claimed lack of association between severe hypoglycemia and future cognitive function. (LLM, conf=0.83)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationThe person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors.
“The person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors (19,56,57)”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [19] 19. de Galan BE, Zoungas S, Chalmers J, et al. Cognitive function and risks of car- diovascular disease and hypoglycaemia in patients with type 2 diabetes: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia 2009;52:2328-36. source
The Results (p. 1) report increased severe-hypoglycaemia risk for patients with severe, but not mild, cognitive dysfunction. The Discussion (p. 7) suggests incomplete adherence or inappropriate use of the glucose-control regimen as a possible explanation, but says this could not be assessed with certainty. The claim is broader than the finding because it does not distinguish severe from mild cognitive dysfunction. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [56] 56. Bruce DG, Davis WA, Casey GP, et al. Severe hypoglycaemia and cognitive impair- ment in older patients with diabetes: The Fremantle Diabetes Study. Diabetologia 2009;52:1808-15. source
The Abstract reports that dementia predicted future hypoglycaemia requiring health-service use in patients with diabetes aged 70 or older, and that inability to self-manage medications was also a risk factor. The Introduction suggests medication errors as a possible mechanism. The claim is broader than the prospective finding: the paper establishes that risk for dementia, not cognitive disorders generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [57] 57. Zhang Z, Lovato J, Battapady H, et al. Effect of hypoglycemia on brain structure in people with type 2 diabetes: Epidemiological analysis of the ACCORD- MIND MRI trial. Diabetes Care 2014;37:3279-85. source
The Introduction discusses severe hypoglycemia as a possible antecedent of cognitive impairment, not cognitive disorders as a predictor of future episodes. The Results and Conclusions identify other factors associated with hypoglycemia, but do not establish increased risk from cognitive disorders or mention medication errors (searched: future episodes, cognitive impairment, medication errors). (LLM, conf=0.72)
Experimental — accuracy not yet measured
May combine two claims.
InterpretationcitationBoth hypoglycemia unawareness and defective glucose counterregulation are potentially reversible.
“Both hypoglycemia unawareness and defective glucose counterregulation are potentially reversible.”
Quote in the paperSubstantial claim2 of 8 sources checked- cites [32] 32. Ovalle F, Fanelli CG, Paramore DS, et al. Brief twice-weekly episodes of hypo- glycemia reduce detection of clinical hypoglycemia in type 1 diabetes melli- tus. Diabetes 1998;47:1472-9. source
- cites [33] 33. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglyce- mia normalizes the glycemic thresholds and magnitude of most of neuroen- docrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Diabetes 1993;42:1683- 9. source
- cites [34] 34. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unaware- ness, but not defective glucose counterregulation, in IDDM. Diabetes 1994;43:1426-34. source
- cites [35] 35. Fanelli C, Pampanelli S, Epifano L, et al. Long-term recovery from unaware- ness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Diabetologia 1994;37:1265-76. source
- cites [36] 36. Dagogo-Jack S, Fanelli CG, Cryer PE. Durable reversal of hypoglycemia unawareness in type 1 diabetes. Diabetes Care 1999;22:866-7. source
- cites [37] 37. Davis M, Mellman M, Friedman S, et al. Recovery of epinephrine response but not hypoglycemic symptom threshold after intensive therapy in type 1 diabetes. Am J Med 1994;97:535-42. source
- cites [38] 38. Liu D, McManus RM, Ryan EA. Improved counter-regulatory hormonal and symp- tomatic responses to hypoglycemia in patients with insulin-dependent diabe- tes mellitus after 3 months of less strict glycemic control. Clin Invest Med 1996;19:71-82.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [39] 39. Lingenfelser T, Buettner U, Martin J, et al. Improvement of impaired counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM. Diabetes Care 1995;18:321-5. source
May combine two claims.
PremisecitationIn people with type 2 diabetes and established or very high risk for cardiovascular disease, there is a clear association between increased mortality and severe hypoglycemia and symptomatic hypoglycemia.
“In people with type 2 diabetes and established, or very high risk for, cardiovascular disease (CVD), there is a clear association between an increased mortality and severe hypoglycemia (62,63) and symptomatic hypoglycemia (64).”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [62] 62. Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2015;372:2197- 206. source
The cited paper's discussion of treatment harms (section headed “Table 1. Baseline Characteristics,” page not provided) mentions hypoglycemia as a possible side effect, while its mortality results compare intensive with standard glucose control. Neither passage examines whether symptomatic hypoglycemia is associated with increased mortality. Searches for “hypoglycemia” and “symptomatic hypoglycemia risk of death association” found no such analysis in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured - cites [63] 63. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010;363:1410-18. source
The Discussion (p. 6) clearly reports an association between severe hypoglycemia and increased mortality. But the Study Population section (p. 3) includes patients with microvascular disease or just one other cardiovascular risk factor, so it does not establish that all participants had established CVD or were at very high CVD risk. The symptomatic-hypoglycemia part is attributed to citation 64, not this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [64] 64. Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptom- atic, severe hypoglycaemia and mortality in type 2 diabetes: Retrospective epi- demiological analysis of the ACCORD study. BMJ 2010;340:b4909. source
May combine two claims.
PremisecitationIn people with type 2 diabetes, risk factors for hypoglycemia include advancing age, severe cognitive impairment, poor health literacy, food insecurity, increased A1C, hypoglycemia unawareness, duration of insulin therapy, renal impairment, and neuropathy.
“Risk factors for hypoglycemia in people with type 2 diabetes include advancing age (18), severe cognitive impairment (19), poor health literacy (20), food insecurity (21), increased A1C (18,22), hypoglycemia unawareness (23), duration of insulin therapy, renal impairment and neuropathy (22).”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [18] 18. Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: Post hoc epidemiological analysis of the ACCORD study. BMJ 2010;340:b5444. source
The Principal findings section reports increased risk with peripheral neuropathy and markers of renal dysfunction. It also reports an association with higher baseline A1C, but after adjustment this was seen only in the standard-treatment group. The paper identifies insulin use and longer duration of diabetes as risk factors, not duration of insulin therapy; the other factors in the sentence are assigned to different citations. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [19] 19. de Galan BE, Zoungas S, Chalmers J, et al. Cognitive function and risks of car- diovascular disease and hypoglycaemia in patients with type 2 diabetes: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia 2009;52:2328-36. source
- cites [20] 20. Sarkar U, Karter AJ, Liu JY, et al. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 2010;25:962-8. source
May combine two claims.
PremisecitationIslet cell transplantation reduces hypoglycemia and restores glucose counter-regulation.
“Islet cell transplantation, which has been shown to reduce hypoglycemia (48) and restore glucose counter-regulation (49), should be considered for people with type 1 diabetes who experience recurrent severe hypoglycemia (50)”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [48] 48. Hering BJ, Clarke WR, Bridges ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care 2016;39:1230-40. source
- cites [49] 49. Rickels MR. Recovery of endocrine function after islet and pancreas transplan- tation. Curr Diab Rep 2012;12:587-96. source
May combine two claims.
PremisecitationAcute hypoglycemia is proinflammatory, increases platelet activation and decreases fibrinolysis, leading to a prothrombotic state.
“Acute hypoglycemia is proinflammatory, increases platelet activation and decreases fibrinolysis, leading to a prothrombotic state (65,66).”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [65] 65. Wright RJ, Newby DE, Stirling D, et al. Effects of acute insulin-induced hypo- glycemia on indices of inflammation: Putative mechanism for aggravating vas- cular disease in diabetes. Diabetes Care 2010;33:1591-7. source
The Results and Conclusions (page unavailable) report increased inflammatory markers and platelet activation after acute hypoglycemia, and discuss possible adverse vascular consequences. They do not establish decreased fibrinolysis or demonstrate that these changes led to a prothrombotic state; tPA antigen was reported as rising nonsignificantly in nondiabetic participants during hypoglycemia. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [66] 66. Gogitidze Joy N, Hedrington MS, Briscoe VJ, et al. Effects of acute hypoglyce- mia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care 2010;33:1529- 35. source
May combine two claims.
PremisecitationHypoglycemia is associated with increased heart rate, systolic blood pressure, myocardial contractility, stroke volume and cardiac output, and can induce ST- and T-wave changes with a lengthening of the QT interval, which may increase the risk of arrhythmias.
“Hypoglycemia is associated with increased heart rate, systolic blood pressure (BP), myocardial contractility, stroke volume and cardiac output, and can induce ST-and T-wave changes with a lengthening of the QT interval (slower repolarization), which may increase the risk of arrhythmias (67)(68)(69)(70)(71).”
Quote in the paperSubstantial claim2 of 5 sources checked- cites [67] 67. Koivikko ML, Karsikas M, Salmela PI, et al. Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes. Diabetologia 2008;51:426-35. source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [68] 68. Kubiak T, Wittig A, Koll C, et al. Continuous glucose monitoring reveals asso- ciations of glucose levels with QT interval length. Diabetes Technol Ther 2010;12:283-6. source
- cites [69] 69. Wright RJ, Frier BM. Vascular disease and diabetes: Is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev 2008;24:353-63. source
- cites [70] 70. Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Dia- betes Care 2011;34(Suppl. 2):S132-7. source
- cites [71] 71. Stahn A, Pistrosch F, Ganz X, et al. Relationship between hypoglycemic epi- sodes and ventricular arrhythmias in patients with type 2 diabetes and cardio- vascular diseases: Silent hypoglycemias and silent arrhythmias. Diabetes Care 2014;37:516-20. source
May combine two claims.
PremisecitationPancreas transplantation reduces hypoglycemia and restores glucose counter-regulation.
“Similarly, pancreas transplantation has been shown to reduce hypoglycemia and restore glucose counter-regulation (43,(51)(52)(53).”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [43] 43. van Dellen D, Worthington J, Mitu-Pretorian OM, et al. Mortality in diabetes: Pancreas transplantation is associated with significant survival benefit. Nephrol Dial Transplant 2013;28:1315-22. source
- cites [51] 51. Kendall DM, Rooney DP, Smets YF, et al. Pancreas transplantation restores epi- nephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy. Diabetes 1997;46:249-57. source
- cites [52] 52. Paty BW, Lanz K, Kendall DM, et al. Restored hypoglycemic counterregulation is stable in successful pancreas transplant recipients for up to 19 years after trans- plantation. Transplantation 2001;72:1103-7. source
- cites [53] 53. Barrou Z, Seaquist ER, Robertson RP. Pancreas transplantation in diabetic humans normalizes hepatic glucose production during hypoglycemia. Diabetes 1994;43:661-6. source
May combine two claims.
PremisecitationStructured educational and psycho-behavioural programs may help improve detection of hypoglycemia and reduce the frequency of severe hypoglycemia.
“Structured educational and psycho-behavioural programs (e.g.BG awareness training) may help improve detection of hypoglycemia and reduce the frequency of severe hypoglycemia (40)(41)(42)(43).”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [40] 40. Kinsley BT, Weinger K, Bajaj M, et al. Blood glucose awareness training and epi- nephrine responses to hypoglycemia during intensive treatment in type 1 dia- betes. Diabetes Care 1999;22:1022-8. source
- cites [41] 41. Schachinger H, Hegar K, Hermanns N, et al. Randomized controlled clinical trial of Blood Glucose Awareness Training (BGAT III) in Switzerland and Germany. J Behav Med 2005;28:587-94. source
- cites [42] 42. Yeoh E, Choudhary P, Nwokolo M, et al. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: A systematic review and meta- analysis. Diabetes Care 2015;38:1592-609. source
- cites [43] 43. van Dellen D, Worthington J, Mitu-Pretorian OM, et al. Mortality in diabetes: Pancreas transplantation is associated with significant survival benefit. Nephrol Dial Transplant 2013;28:1315-22. source
May combine two claims.
PremisecitationFrequent hypoglycemia can decrease normal responses to hypoglycemia and lead to defective glucose counter-regulation and hypoglycemia unawareness.
“Frequent hypoglycemia can decrease normal responses to hypoglycemia (12) and lead to defective glucose counter-regulation and hypoglycemia unawareness.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] 12. Davis EA, Keating B, Byrne GC, et al. Hypoglycemia: Incidence and clinical pre- dictors in a large population-based sample of children and adolescents with IDDM. Diabetes Care 1997;20:22-5. source
Classified as probably not a substantial claim.
PremisecitationPeople with diabetes who continue to have frequent and severe hypoglycemia and/or impaired awareness despite educational interventions may benefit from CSII or CGM or both to reduce the risk of severe hypoglycemia.
“People with diabetes who continue to have frequent and severe hypoglycemia and/or impaired awareness of hypoglycemia, despite educational interventions, may benefit from continuous subcutaneous insulin infusion (CSII) therapy or continuous glucose monitoring (CGM) or both (i.e. a sensor augmented pump), to reduce the risk of severe hypoglycemia (44)(45)(46)(47).”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [44] 44. Ly TT, Nicholas JA, Retterath A, et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: A randomized clinical trial. JAMA 2013;310:1240-7. source
- cites [45] 45. Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia aware- ness in long-standing type 1 diabetes: A multicenter 2 x 2 factorial random- ized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care 2014;37:2114-22. source
- cites [46] 46. Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med 2013;369:224- 32. source
- cites [47] 47. van Beers CAJ, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): A randomised, open-label, crossover trial. Lancet Diabetes Endocrinol 2016;4:893-902. source
May combine two claims.
PremisecitationGlucose gel is quite slow (<1.0 mmol/L increase at 20 minutes) and must be swallowed to have a significant effect.
“Glucose gel is quite slow (<1.0 mmol/L increase at 20 minutes) and must be swallowed to have a significant effect (73)(74)(75)(76)(77)(78).”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [73] 73. Slama G, Traynard PY, Desplanque N, et al. The search for an optimized treatment of hypoglycemia. carbohydrates in tablets, solutin, or gel for the correction of insulin reactions. Arch Intern Med 1990;150:589-93. source
- cites [74] 74. Wiethop BV, Cryer PE. Alanine and terbutaline in treatment of hypoglycemia in IDDM. Diabetes Care 1993;16:1131-6. source
- cites [75] 75. Brodows RG, Williams C, Amatruda JM. Treatment of insulin reactions in dia- betics. JAMA 1984;252:3378-81. source
- cites [76] 76. Skyler JS (Ed.): Medical Management of Type 1 Diabetes. 3rd ed. Alexandria, VA, American Diabetes Association, 1998. pg. 134-43.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [77] 77. Canadian Diabetes Association. The role of dietary sugars in diabetes mellitus. Beta Release 1991;15:117-23.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [78] 78. Gunning RR, Garber AJ. Bioactivity of instant glucose. Failure of absorption through oral mucosa. JAMA 1978;240:1611-12. source
May combine two claims.
PremisecitationOther choices, such as milk and orange juice, are slower to increase blood glucose levels and provide symptom relief.
“Other choices, such as milk and orange juice, are slower to increase BG levels and provide symptom relief (74,75).”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim.
PremisecitationPeople taking an alpha glucosidase inhibitor (acarbose) must use glucose (dextrose) tablets or, if unavailable, milk or honey to treat hypoglycemia.
“People taking an alpha glucosidase inhibitor (acarbose) must use glucose (dextrose) tablets (79) or, if unavailable, milk or honey to treat hypoglycemia.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [79] 79. Glucobay® (acarbose) [product monograph]. Toronto: Bayer Inc, 2007.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationThe effectiveness of glucagon is reduced in individuals who have consumed more than 2 standard alcoholic drinks in the previous few hours, after prolonged fasting, or in those who have advanced hepatic disease.
“The effectiveness of glucagon is reduced in individuals who have consumed more than 2 standard alcoholic drinks in the previous few hours, after prolonged fasting, or in those who have advanced hepatic disease (81,82).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [81] 81. Glucagon [product monograph]. Toronto: Eli Lilly Canada, Inc, 2007.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [82] 82. GlucaGen® (glucagon) [product monograph]. Bagsvaerd: Novo Nordisk, 2002.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
Drug-induced hypoglycemia is a major obstacle for individuals trying to achieve glycemic targets.
“Drug-induced hypoglycemia is a major obstacle for individuals trying to achieve glycemic targets.”
The paper relies on this without support.
Significant risk of hypoglycemia often necessitates less stringent glycemic goals.
“Significant risk of hypoglycemia often necessitates less stringent glycemic goals.”
The paper relies on this without support.
The negative social and emotional impact of hypoglycemia may make individuals reluctant to intensify therapy.
“The negative social and emotional impact of hypoglycemia may make individuals reluctant to intensify therapy.”
The paper relies on this without support.
Hypoglycemia is most frequent in people with type 1 diabetes, followed by people with type 2 diabetes managed by insulin, and people with type 2 diabetes managed by sulfonylureas.
“Hypoglycemia is most frequent in people with type 1 diabetes, followed by people with type 2 diabetes managed by insulin, and people with type 2 diabetes managed by sulfonylureas.”
The paper relies on this without support.
Short-term risks of hypoglycemia include dangerous situations that can arise while an individual is hypoglycemic, whether at home or at work.
“Short-term risks of hypoglycemia include the dangerous situations that can arise while an individual is hypoglycemic, whether at home or at work (e.g.driving, operating machinery).”
The paper relies on this without support.
Prolonged coma is sometimes associated with transient neurological symptoms, such as paresis, convulsions and encephalopathy.
“In addition, prolonged coma is sometimes associated with transient neurological symptoms, such as paresis, convulsions and encephalopathy.”
The paper relies on this without support.
The potential long-term complications of severe hypoglycemia are mild intellectual impairment and permanent neurologic sequelae, such as hemiparesis and pontine dysfunction.
“The potential long-term complications of severe hypoglycemia are mild intellectual impairment and permanent neurologic sequelae, such as hemiparesis and pontine dysfunction.”
The paper relies on this without support.
There is a clear association between severe hypoglycemia and cognitive disorders, but the nature of this relationship remains unclear.
“There is a clear association between severe hypoglycemia and cognitive disorders, but the nature of this relationship remains unclear.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Metformin is widely used as a first-line treatment for type 2 diabetes mellitus owing to its excellent tolerability, safety profile, and lack of hypoglycemic effect.
“Isolated from French lilac in 1920s, metformin (dimethylbiguanide) has been widely used as a first-line treatment for type 2 diabetes mellitus (DM2), owing to its excellent tolerability, safety profile, and lack of hypoglycemic effect (3–6).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [4]
Some factors associated with early hypoglycaemia, such as prior hypoglycaemia, have been associated with hypoglycaemia risk in previous studies.
“Some of these factors, such as prior hypoglycaemia, have been associated with hypoglycaemia risk in previous studies.26,27”
From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [26]
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BackgroundDİYABETİK OLMAYAN HASTALARDA HİPOGLİSEMİ
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Valores críticos de laboratorio. Valores clínicamente irrelevantes
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Tata Laksana Hipoglikemia pada Pasien Diabetes
Pramudya, R., & Amiralevi, S. H. (2025) · Cermin Dunia Kedokteran · doi:10.55175/cdk.v52i1.1254
Oral health implications and its management for type 1 diabetes children: A narrative review
Pachani, H., Bargale, S. D., Dave, B. H., et al. (2025) · SRM Journal of Research in Dental Sciences · doi:10.4103/srmjrds.srmjrds_140_24
NURSING DIAGNOSIS IN PATIENTS WITH HYPOGLYCEMIA IN THEEMERGENCY DEPARTMENT
Hidayati, N. L., Aldia, M. A. P., & Maghfuroh, L. (2025) · INTERNATIONAL JOURNAL OF NURSING AND MIDWIFERY SCIENCE (IJNMS) · doi:10.29082/ijnms/2025/vol9/iss2/717
“These symptoms are manifestations of the body ’ s physiological response to a lack of glucose, the brain ’ s and other body tissues ’ main source of energy (Yale et al., 2018).”
When Acarbose Overdose Turns Severe: Managing Hypoglycemia in an Uncommon Scenario
Shrestha, A., Poudel, N., Acharya, K., et al. (2025) · Clinical Case Reports · doi:10.1002/ccr3.71448
Wrist Phantom Modeling Using MRI Images for Noninvasive Blood Glucose Monitoring
Woo, H., Lee, H., & Yook, J. (2025) · IEEE International Symposium on Antennas and Propagation and North American Radio Science Meeting (AP-S/URSI) · doi:10.1109/ap-s/cnc-usnc-ursi55537.2025.11266822
- Authors
- Yale, J.-F., Paty, B., & Senior, P. A.
- Venue
- Canadian Journal of Diabetes
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 42
- Pages
- S104-S108
- ISSN
- 1499-2671 (ISSN-L)
- OpenAlex
- W4235584775
- Cited by
- 105
- References
- 82
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 19 · 2023: 13 · 2022: 22 · 2021: 14 · 2020: 10 · 2019: 7 · 2018: 1
- FWCI
- 6.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Canadian Journal of Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- hypoglycemia, drug-induced hypoglycemia, glycemic control, glycemic targets, fear of hypoglycemia, quality of life, self-care, diabetes mellitus
- MeSH terms
- Diabetes Mellitus, Humans, Hypoglycemia, Hypoglycemic Agents, Prognosis, Practice Guidelines as Topic
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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.
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