Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes
Open accessAbstract
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 ≥70 mg/dL 30 minutes after intervention, on the study meter. 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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Alpha-glucosidase inhibitors block the digestion and uptake of complex carbohydrates and disaccharides.
“In persons with T2D being treated with alpha-glucosidase inhibitors, who develop hypoglycemia due to use of hypoglycemic agents, oral glucose or lactose-containing foods (dairy products) must be given because alpha-glucosidase inhibitors inhibit the breakdown and absorption of complex carbohydrates and disaccharides.1218–1225”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1221]
The Discussion reports that oral glucose tablets treated hypoglycemia in adults with type 1 diabetes, but does not discuss alpha-glucosidase inhibitors or their effects on carbohydrate digestion and absorption. Searches for the inhibitor mechanism, complex carbohydrates, disaccharides, and lactose found no passage addressing the attributed claim. Page numbers were not available in our copy. (LLM, conf=0.76)
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- Authors
- Haymond, M. W., DuBose, S. N., Rickels, M. R., Wolpert, H., Shah, V. N., Sherr, J. L., Weinstock, R. S., Agarwal, S., Verdejo, A. S., Cummins, M. J., Newswanger, B., Beck, R. W., & for the T1D Exchange Mini-dose Glucagon Study Group
- Affiliations
- Baylor College of Medicine (US)
- Jaeb Center for Health Research (US)
- University of Pennsylvania (US)
- Joslin Diabetes Center (US)
- University of Colorado Anschutz (US)
- Yale University (US)
- SUNY Upstate Medical University (US)
- Xeris Pharmaceuticals (United States) (US)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2017-06-07
- Volume
- 102
- Issue
- 8
- Pages
- 2994-3001
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2624087031
- Cited by
- 42
- References
- 13
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 9 · 2021: 4 · 2020: 9 · 2019: 6 · 2018: 5 · 2017: 1
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yale University
- University of Pennsylvania
- Syracuse University
- State University of New York
- Joslin Diabetes Center
- Dexcom
- Perelman School of Medicine, University of Pennsylvania
- State University of New York Upstate Medical University
- 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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- type 1 diabetes, hypoglycemia treatment, insulin pump, continuous glucose monitoring, time in range, hyperglycemia, adults
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 1, Female, Glucagon, Hormones, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Middle Aged, Severity of Illness Index, Blood Glucose Self-Monitoring, Cross-Over Studies
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