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30 "Hypoglycemia"
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Original Articles
Diabetes, obesity and metabolism
Efficacy and Safety of Omarigliptin, a Novel Once-Weekly Dipeptidyl Peptidase-4 Inhibitor, in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
A.B.M. Kamrul-Hasan, Muhammad Shah Alam, Samir Kumar Talukder, Deep Dutta, Shahjada Selim
Endocrinol Metab. 2024;39(1):109-126.   Published online January 23, 2024
DOI: https://doi.org/10.3803/EnM.2023.1839
  • 1,191 View
  • 40 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
No recent meta-analysis has holistically analyzed and summarized the efficacy and safety of omarigliptin in type 2 diabetes mellitus (T2DM). We conducted a meta-analysis to address this knowledge gap.
Methods
Electronic databases were searched to identify randomized controlled trials (RCTs) that included patients with T2DM who received omarigliptin in the intervention arm. The control arm consisted of either a placebo (passive control group [PCG]) or an active comparator (active control group [ACG]). The primary outcome assessed was changes in hemoglobin A1c (HbA1c), while secondary outcomes included variations in glucose levels, achievement of glycemic targets, adverse events (AEs), and hypoglycemic events.
Results
From 332 initially screened articles, data from 16 RCTs involving 8,804 subjects were analyzed. Omarigliptin demonstrated superiority over placebo in reducing HbA1c levels (mean difference, –0.58%; 95% confidence interval, –0.75 to –0.40; P<0.00001; I2=91%). Additionally, omarigliptin outperformed placebo in lowering fasting plasma glucose, 2-hour postprandial glucose, and in the percentage of participants achieving HbA1c levels below 7.0% and 6.5%. The glycemic efficacy of omarigliptin was similar to that of the ACG across all measures. Although the omarigliptin group experienced a higher incidence of hypoglycemic events compared to the PCG, the overall AEs, serious AEs, hypoglycemia, and severe hypoglycemia were comparable between the omarigliptin and control groups (PCG and ACG).
Conclusion
Omarigliptin has a favorable glycemic efficacy and safety profile for managing T2DM.
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Clinical Study
Big Data Articles (National Health Insurance Service Database)
Effect of Teneligliptin versus Sulfonylurea on Major Adverse Cardiovascular Outcomes in People with Type 2 Diabetes Mellitus: A Real-World Study in Korea
Da Hea Seo, Kyoung Hwa Ha, So Hun Kim, Dae Jung Kim
Endocrinol Metab. 2021;36(1):70-80.   Published online February 24, 2021
DOI: https://doi.org/10.3803/EnM.2020.777
  • 4,976 View
  • 192 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Results regarding the cardiovascular (CV) effects of dipeptidyl peptidase-4 (DPP-4) inhibitors are inconsistent. This study aimed to assess the effects of teneligliptin, a DPP-4 inhibitor, on the risk of major CV outcomes in type 2 diabetes mellitus (T2DM) patients compared to sulfonylurea.
Methods
From January 1, 2015 to December 31, 2017, we conducted a retrospective cohort study using the Korean National Health Insurance Service database. A total of 6,682 T2DM patients who were newly prescribed DPP-4 inhibitors or sulfonylurea were selected and matched in a 1:1 ratio by propensity score. The hazard ratios (HRs) for all-cause mortality, hospitalization for heart failure (HHF), all-cause mortality or HHF, myocardial infarction (MI), stroke, and hypoglycemia were assessed.
Results
During 641 days of follow-up, the use of teneligliptin was not associated with an increased risk of all-cause mortality (HR, 1.00; 95% confidence interval [CI], 0.85 to 1.19), HHF (HR, 0.99; 95% CI, 0.86 to 1.14), all-cause mortality or HHF (HR, 1.02; 95% CI, 0.90 to 1.14), MI (HR, 0.90; 95% CI, 0.68 to 1.20), and stroke (HR, 1.00; 95% CI, 0.86 to 1.17) compared to the use of sulfonylurea. However, it was associated with a significantly lower risk of hypoglycemia (HR, 0.68; 95% CI, 0.49 to 0.94) compared to sulfonylurea therapy.
Conclusion
Among T2DM patients, teneligliptin therapy was not associated with an increased risk of CV events including HHF, but was associated with a lower risk of hypoglycemia compared to sulfonylurea therapy.

Citations

Citations to this article as recorded by  
  • Association between age at diagnosis of type 2 diabetes and cardiovascular morbidity and mortality risks: A nationwide population-based study
    Da Hea Seo, Mina Kim, Young Ju Suh, Yongin Cho, Seong Hee Ahn, Seongbin Hong, So Hun Kim
    Diabetes Research and Clinical Practice.2024; 208: 111098.     CrossRef
  • Systematic review and meta-analysis of teneligliptin for treatment of type 2 diabetes
    R. Pelluri, S. Kongara, V. R. Nagasubramanian, S. Mahadevan, J. Chimakurthy
    Journal of Endocrinological Investigation.2023; 46(5): 855.     CrossRef
  • Finding the most cost-effective option from commonly used Dipeptidyl peptidase-4 inhibitors in India: a systematic study
    Harmanjit Singh, Ekta Arora, Seerat Narula, Mandeep Singla, Armaan Otaal, Jatin Sharma
    Expert Review of Endocrinology & Metabolism.2023; 18(4): 347.     CrossRef
  • Association Between DPP4 Inhibitor Use and the Incidence of Cirrhosis, ESRD, and Some Cancers in Patients With Diabetes
    Yewon Na, Soo Wan Kim, Ie Byung Park, Soo Jung Choi, Seungyoon Nam, Jaehun Jung, Dae Ho Lee
    The Journal of Clinical Endocrinology & Metabolism.2022; 107(11): 3022.     CrossRef
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Case Reports
A Case with Isolated ACTH Deficiency.
Myoung Sik Kim, Byung Doo Lee, Sang Min Shin, Young Il Kim, Byung Oh Jeong, Hong Jib Choi, Phil Ho Kim, Kyung Soo Ko, Jae Hong Park
J Korean Endocr Soc. 1996;11(4):538-543.   Published online November 7, 2019
  • 1,202 View
  • 51 Download
AbstractAbstract PDF
Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. Adrenal crisis in isolated ACTH deficiency is less common compared to primary adrenal insufficiency, but isolated ACTH deficiency is an important cause of hypoglycemia. Recently we experienced a 41-year-old man admitted because of mental confusion. On admission, plasma glucose and sodium concentration were 1.7, 132 mmol/L, respectively. Basal plasma ACTH and cortisol levels were low and other pituitary hormone showed normal response to combined pituitary stimulation test except growth hormone. Plasma ACTH concentration remained low even after intravenous injection of ovine corticotropin releasing factor. It suggest that the defect of ACTH secretion was apparently due to intrinsic pituitary rather than hypothalamic disease. The sellar CT showed the fossa to be filled by cerebrospinal fluid. After treatment with glucocorticoid, he had no further evidence of hypoglycemia and hyponatremia. In conclusion, we report a case of isolated ACTH deficiency with empty sella.
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Diffuse Nesidioblastosis of the Pancreasin Adult with Persistent Hyperinsulinemic Hypoglycemia.
Seoung Ha Lee, Kean Young Hyoung, Geom Seog Seo, Bong Joo Shin, Chung Gu Cho, Kwang Soo Yang, Kwon Mook Chae, Ki Jung Yun
J Korean Endocr Soc. 1996;11(2):247-253.   Published online November 7, 2019
  • 1,033 View
  • 19 Download
AbstractAbstract PDF
Nesidioblastosis is a term that describes multifocal hyperplasia of all panereatic cell components and is characterized primarily by their disorganization and proliferation throughout the entire panaeas. Adult onset nesidioblastosis is an extremely rare entity associated with hypersecretion of insulin. The authors have recently experieneed a case of nesidioblastosis in an adult. A 41-year old man was admitted due to interrnittenr hypoglycemic symptoms, that had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during prolonged fast. Under the presumptive diagnosis of insulinoma, abdominal CT, celiac angiogram and percutaneous transhepatic portal venous sampling were done but we could not find any definitive mass. Eight-five percent of the panacas was removed. Pathologic examination of the resected pancreas revealed irregularly sized islets and scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.
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Two Cases of hypoglycemia in IDDM patients with insulin antibody.
G A Kim, K W Lee, M R Kim, Y J Kim, J N Jang, S K Bae, B G Son
J Korean Endocr Soc. 1996;11(2):240-246.   Published online November 7, 2019
  • 1,024 View
  • 19 Download
AbstractAbstract PDF
Hirata et al. first described the association of insulin antibodies with hypoglycemia attacks and decreased glucose tolerance in a patient who had not previously received insulin injections. Since that time there have been additional reports in the Japanese literature. Insulin antibodies are present in most of the patients who received insulin for a period of time, usually exceeding six weeks. There were several reports of hypoglycemia in patients with non-insulin-dependent diabetes mellitus who had developed insulin antibody after insulin administration and also in patients with insulin dependent diabetes mellitus. It is well known that either insulin antibody to the lower affinity site or insulin receptor antibody can be a eause of hypoglycemia. Recently, we experienced two cases of hypoglycemia in patient with insulin dependent diabetes rnellitus and non- insulin- dependent diabetes mellitus who had developed insulin antibody after insulin administration. Hereby we present these cases with review of the literature.
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A Case of Non - Islet Cell Tumor Hypoglycemia.
Moon Hee Lee, Seung Sik Kang, Jin Lee, Sung Hee Ihm, Jae Myung Yoo, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park
J Korean Endocr Soc. 1995;10(1):65-69.   Published online November 6, 2019
  • 1,146 View
  • 32 Download
AbstractAbstract PDF
The association between non-islet cell tumors and fasting hypoglycemia has been recognized since 1929. The humoral mediator of this non-islet cell tumor hypoglycemia(NICTH) is now known as IGF-II. Hypoglycemia develops commonly in the course of hepatocellular carcinoma(HCC), mostly late in the course and usually mild to moderate in severity. Rarely, severe hypoglycemia occurs early in the course of HCC, suggesting NICTH. We report a case of HCC in which hypoglycemic coma due to NICTH was the presenting symptom.A 52-year-old man developed mental confusion and seizures in the early morning. At emergency room, he was found to have severe hypoglycemia. Circulating levels of insulin, C-peptide, insulinlike growth factor-I(IGF-I) and growth hormone were reduced during hypoglycemia. Diagnostic work-up revealed that he had unresectable HCC. During admission, infusion of more than 400g of dextrose per day in addition to meals was required to prevent hypoglycemia. Because the chemotherapy was refused, he was transferred to a local hospital to receive infusions of dextrose.
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A Case of Nesidioblastosis in Adult with Hyperinsulinemic Hypoglycemia.
Young Kee Shong, Hong Kyu Kim, Young Joo Min, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee, Duck Jong Han, Ho Jeong Lee, Ghi Su Kim, Gyung Yub Gong
J Korean Endocr Soc. 1994;10(3):273-277.   Published online November 6, 2019
  • 1,087 View
  • 20 Download
AbstractAbstract PDF
Nesidioblastosis is a primarily childhood disease which is often associated with hyperinsulinemic hypoglycemia. It is very rarely found in adults. Only a few well documented cases are found in the world interature. The authors have recently experienced a case of nesidioblastosis in an adult. A 55-year-old man was admitted due to repeated episodes of reversible loss of consciousness. Hyperinsulinemic hypoglycemia was documented. Under the presumptive diagnosis of insulinoma, localization procedures were done but no definite tumor was found. Only suspicious gradient in insulin concentration was found around the head of pancreas by percutaneous transhepatic portal venous sampling. Exploratory laparotomy was performed and Whipple's operation was done. Seventy percent of proximal pancreas was removed. Histomorphometric study of the resected specimen revealed uneven graded hyperplasia of the islet cells with the most profuse hyperplasia in the head region and progressive decrease in the degree of hyperplasia to the body and tail. The patient remains euglycemia until 6 months after operation since immediate postoperative period and can tolerate 24 hour fasting without any medication.
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Original Articles
Clinical Study
Impaired Cortisol and Growth Hormone Counterregulatory Responses among Severe Hypoglycemic Patients with Type 2 Diabetes Mellitus
Young A Rhyu, Ju-Young Jang, Sooyoun Park, Jee Hyun An, Dong-Lim Kim, Suk Kyeong Kim, Kee-Ho Song
Endocrinol Metab. 2019;34(2):187-194.   Published online June 24, 2019
DOI: https://doi.org/10.3803/EnM.2019.34.2.187
  • 5,007 View
  • 75 Download
  • 10 Web of Science
  • 12 Crossref
AbstractAbstract PDFPubReader   ePub   
Background

Elevated levels of cortisol and growth hormone are critical counterregulatory responses to severe hypoglycemia. However, the proportion and clinical characteristics of patients with type 2 diabetes mellitus (DM) who fail to show appropriate cortisol and/or growth hormone secretion in response to severe hypoglycemia have not been investigated.

Methods

We measured plasma cortisol and growth hormone levels in type 2 DM patients with severe hypoglycemia who visited the emergency department between 2006 and 2015.

Results

Of 112 hypoglycemic patients, 23 (20.5%) had an impaired cortisol response (<18 µg/dL) and 82 patients (73.2%) had an impaired growth hormone response (<5 ng/mL). Nineteen patients (17.0%) had impaired responses to both cortisol and growth hormone. The patients with impaired responses of cortisol, growth hormone, and both hormones were significantly older and more likely to be female, and had higher admission rates, lower growth hormone levels, and lower adrenocorticotropic hormone levels than the patients with a normal hormonal response. Multivariate logistic regression analysis indicated that an impaired growth hormone response was significantly associated with advanced age, shorter DM duration, a higher admission rate, and a higher body mass index (BMI). An impaired cortisol response was significantly associated with growth hormone levels. Patients with an impaired growth hormone response had higher admission rates than patients with a normal response.

Conclusion

A considerable number of type 2 DM patients had impaired cortisol and/or growth hormone responses to severe hypoglycemia. Advanced age, shorter DM duration, and higher BMI were independently associated with an abnormal growth hormone response.

Citations

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    Ozlem Deveci, Zuleyha Karaca, Fatih Tanriverdi, Kamil Deveci, Aysa Hacioglu, Kursad Unluhizarci, Fahrettin Kelestimur
    Annales d'Endocrinologie.2023; 84(2): 254.     CrossRef
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    María Eugenia Gullace, María Victoria Ortuño, Teresa Mabel Canteros, Belén Bosco, Cintia Rodriguez, Javier Giunta, Lucas Costa, Andrea Kozak, Valeria de Miguel, Luis Grosembacher
    Endocrinología, Diabetes y Nutrición.2023; 70(10): 634.     CrossRef
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    María Eugenia Gullace, María Victoria Ortuño, Teresa Mabel Canteros, Belén Bosco, Cintia Rodriguez, Javier Giunta, Lucas Costa, Andrea Kozak, Valeria de Miguel, Luis Grosembacher
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    Felipe Duarte-Zambrano, Jorge A. Barrero, Ismena Mockus
    Dementia & Neuropsychologia.2023;[Epub]     CrossRef
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    Maria Crespo-Masip, Aurora Pérez-Gómez, Carla Guzmán, Sandra Rayego, Nuria Doladé, Alicia García-Carrasco, Ramiro Jover, José Manuel Valdivielso
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Beta Blockers can Mask not only Hypoglycemia but also Hypotension
    Goran Koracevic, Sladjana Micic, Milovan Stojanovic, Radmila Velickovic Radovanovic, Milan Pavlovic, Tomislav Kostic, Dragan Djordjevic, Nebojsa Antonijevic, Maja Koracevic, Vesna Atanaskovic, Sonja Dakic
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    Małgorzata Landowska, Agata Żebrowska, Konrad Fajer, Patrycja Adamek, Aleksandra Kruk, Bernadetta Kałuża, Edward Franek
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 3133.     CrossRef
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Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety
Abdallah M. Beano, Mohammad A. Zmaili, Zaid H. Gheith, Ahmad M. Naser, Munther S. Momani, Al-Motassem F. Yousef, Ayman A. Zayed
Endocrinol Metab. 2017;32(2):265-273.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.265
  • 4,036 View
  • 41 Download
  • 10 Web of Science
  • 12 Crossref
AbstractAbstract PDFPubReader   
Background

Many Muslim type 2 diabetes mellitus (T2DM) patients choose to fast the month of Ramadan despite the possible adverse health effects brought about by the change in dietary habits, among other things. Clinical data regarding the safety of multi-drug regimens during fasting are particularly scarce. The aim of the study was to evaluate the safety of a drug protocol devised by the authors to accommodate Ramadan's dietary changes, involving dose adjustments of four anti-diabetic drug regimens in T2DM patients fasting Ramadan.

Methods

In this prospective, observational, open-label study, 301 T2DM patients who wished to fast Ramadan were followed during Ramadan and the preceding month. The incidence of hypoglycemia, diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar state (NKHS) was monitored. Patients were classified into four groups: A group (those taking metformin, sulfonylurea and insulin [n=33]); B group (metformin and sulfonylurea [n=89]); C group (metformin and insulin [n=96]); and D group (premixed 70/30, glargine or regular insulin [n=82]). During Ramadan, drug doses were adjusted as percentages of their pre-Ramadan values: 75% for sulfonylureas, 75% for glargine, 75% for premixed insulin 70/30 in two doses, and 75% for regular insulin. Metformin was adjusted to a twice-daily regimen.

Results

No cases of DKA or NKHS were reported. Hypoglycemia occurred at a lower rate than pre-Ramadan values in groups C, and D; and a similar rate in groups A, and B.

Conclusion

The data suggested that using the above protocol to adjust the doses of anti-diabetic drugs is safe in T2DM patients in regards to hypoglycemia, DKA, and NKHS.

Citations

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    Yifei Zhang, Zehan Zhang, Qingqian Yu, Bijuan Lan, Qinghuan Shi, Ruting Li, Ziheng Jiao, Weiyue Zhang, Feng Li
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    Majid Alabbood, Rafid Alameri, Yasameen Alsaffar
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    Abeer Alhaj, Omar F Shatnawi
    JAP Academy Journal.2023;[Epub]     CrossRef
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    Fateen Ata, Adeel Ahmad Khan, Ibrahim Khamees, Mohammed Bashir
    Current Medical Research and Opinion.2023; 39(8): 1061.     CrossRef
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    Rahmatullah, Muhammad Yakoob Ahmedani, Abdul Basit, Shagufta Zia, Imran Hasan, Qazi Masroor, Abrar Shaikh, Jehangir Khan, Waheed Iqbal
    Diabetes Research and Clinical Practice.2022; 185: 109234.     CrossRef
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    Alexander Kieu, Ashley Iles, Moien AB Khan, Linda Östlundh, Duston Boyd, MoezAlIslam Ezzat Faris
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Close layer
Review Articles
Hypoglycemia and Dementia
Sang Youl Rhee
Endocrinol Metab. 2017;32(2):195-199.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.195
  • 4,320 View
  • 67 Download
  • 10 Web of Science
  • 11 Crossref
AbstractAbstract PDFPubReader   

Recently, cardiovascular morbidity and mortality have been continuously reduced in people with diabetes through the intensive management of multiple risk factors. However, contrary to this trend, the prevalence and clinical significance of neurodegenerative disorders are steadily increasing. In previous studies, diabetes mellitus has been found to play an important role in increasing the risk of dementia and cognitive dysfunction through various mechanisms. In particular, hypoglycemia is a frequent clinical situation in the strict management of diabetes and is well known as an important factor that directly affects the risk of dementia and cognitive impairment. This article describes the occurrence of hypoglycemia in patients with diabetes, and summarizes the resultant risks of dementia and cognitive dysfunction.

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    Olga V. Saik, Vadim V. Klimontov
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Stepwise Approach to Problematic Hypoglycemia in Korea: Educational, Technological, and Transplant Interventions
Sang-Man Jin
Endocrinol Metab. 2017;32(2):190-194.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.190
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AbstractAbstract PDFPubReader   

Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring. The next step is a sensor-augmented pump, preferably with a low glucose suspension feature or very frequent contact, and the final step is islet or pancreas transplantation. In Korea, however, none of these treatments are reimbursed by the National Health Insurance, and thus have not been widely implemented. The low prevalence of type 1 diabetes means that Korean physicians are relatively unfamiliar with the new technologies in this field. Therefore, the roles of new technologies and pancreas or islet transplantation in the treatment of problematic hypoglycemia need to be defined in the current clinical setting of Korea.

Citations

Citations to this article as recorded by  
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Original Articles
Clinical Study
1,5-Anhydro-D-Glucitol Could Reflect Hypoglycemia Risk in Patients with Type 2 Diabetes Receiving Insulin Therapy
Min Kyeong Kim, Hye Seung Jung, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Seong Yeon Kim
Endocrinol Metab. 2016;31(2):284-291.   Published online May 27, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.2.284
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AbstractAbstract PDFPubReader   
Background

The identification of a marker for hypoglycemia could help patients achieve strict glucose control with a lower risk of hypoglycemia. 1,5-Anhydro-D-glucitol (1,5-AG) reflects postprandial hyperglycemia in patients with well-controlled diabetes, which contributes to glycemic variability. Because glycemic variability is related to hypoglycemia, we aimed to evaluate the value of 1,5-AG as a marker of hypoglycemia.

Methods

We enrolled 18 adults with type 2 diabetes mellitus (T2DM) receiving insulin therapy and assessed the occurrence of hypoglycemia within a 3-month period. We measured 1,5-AG level, performed a survey to score the severity of hypoglycemia, and applied a continuous glucose monitoring system (CGMS).

Results

1,5-AG was significantly lower in the high hypoglycemia-score group compared to the low-score group. Additionally, the duration of insulin treatment was significantly longer in the high-score group. Subsequent analyses were adjusted by the duration of insulin treatment and mean blood glucose, which was closely associated with both 1,5-AG level and hypoglycemia risk. In adjusted correlation analyses, 1,5-AG was negatively correlated with hypoglycemia score, area under the curve at 80 mg/dL, and low blood glucose index during CGMS (P=0.068, P=0.033, and P=0.060, respectively).

Conclusion

1,5-AG level was negatively associated with hypoglycemia score determined by recall and with documented hypoglycemia after adjusting for mean glucose and duration of insulin treatment. As a result, this level could be a marker of the risk of hypoglycemia in patients with well-controlled T2DM receiving insulin therapy.

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Obesity and Metabolism
Optimal Candidates for the Switch from Glimepiride to Sitagliptin to Reduce Hypoglycemia in Patients with Type 2 Diabetes Mellitus
Hyun Min Kim, Jung Soo Lim, Byung-Wan Lee, Eun-Seok Kang, Hyun Chul Lee, Bong-Soo Cha
Endocrinol Metab. 2015;30(1):84-91.   Published online March 27, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.1.84
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AbstractAbstract PDFPubReader   
Background

Sitagliptin is a novel antidiabetic agent with a low risk for hypoglycemia. We investigated the efficacy and safety of sitagliptin when patients switched from a sulfonylurea to sitagliptin and identified good candidates for the switch.

Methods

Sixty-one patients with type 2 diabetes switched from glimepiride with metformin to sitagliptin with metformin due to clinical hypoglycemia. Serum glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour postprandial plasma glucose (2h-PPG) before and 12 and 24 weeks after the drug switch were checked.

Results

HbA1c and FPG levels did not change 12 or 24 weeks after the switch; however, the 2h-PPG level decreased from 218.0±67.5 mg/dL at baseline to 197.1±69.9 mg/dL at 12 weeks and 192.3±67.4 mg/dL at 24 weeks after switching drugs (P=0.045, P=0.018, respectively). All but one patient no longer experienced hypoglycemia after discontinuing glimepiride. In a multivariate logistic regression analysis, a high homeostasis model assessment of insulin resistance and low baseline HbA1c level were independent predictors of an HbA1c ≤7% after switching to sitagliptin.

Conclusion

Glycemic control was not aggravated in patients 24 weeks after the drug switch, and symptomatic hypoglycemia decreased significantly. Patients with dominant insulin resistance may be good candidates for switching from a sulfonylurea to sitagliptin to reduce hypoglycemia.

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Case Report
Obesity and Metabolism
Recurrent Hypoglycemia Triggered by Sorafenib Therapy in a Patient with Hemangiopericytoma
Si Won Lee, Eun Kyung Lee, Tak Yun, Young-Woong Won, Eun Jeong Ko, Mihong Choi, Sang Il Choi, Sun Seob Park, Eun Kyung Hong
Endocrinol Metab. 2014;29(2):202-205.   Published online June 26, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.2.202
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  • 5 Web of Science
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AbstractAbstract PDFPubReader   

Targeted therapy has been proven to be one of the most effective cancer treatments. However, some endocrine disorders can occur during treatment with targeted agents. We report the case of a patient who exhibited a wax and wane pattern of hypoglycemia that was attributed to sorafenib therapy. A 32-year-old woman with metastatic hemangiopericytoma visited the emergency department in a stuporous state. Nonhyperinsulinemic hypoglycemia was diagnosed, was exacerbated shortly after sorafenib therapy, and was improved by the cessation of sorafenib with additional glucocorticoid therapy. Patients with metastatic hemangiopericytoma should be carefully monitored with particular attention to hypoglycemia when sorafenib therapy is initiated.

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Review Article
Obesity and Metabolism
Neurocognitive Changes and Their Neural Correlates in Patients with Type 2 Diabetes Mellitus
Junghyun H Lee, Yera Choi, Chansoo Jun, Young Sun Hong, Han Byul Cho, Jieun E Kim, In Kyoon Lyoo
Endocrinol Metab. 2014;29(2):112-121.   Published online June 26, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.2.112
  • 4,730 View
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AbstractAbstract PDFPubReader   

As the prevalence and life expectancy of type 2 diabetes mellitus (T2DM) continue to increase, the importance of effective detection and intervention for the complications of T2DM, especially neurocognitive complications including cognitive dysfunction and dementia, is receiving greater attention. T2DM is thought to influence cognitive function through an as yet unclear mechanism that involves multiple factors such as hyperglycemia, hypoglycemia, and vascular disease. Recent developments in neuroimaging methods have led to the identification of potential neural correlates of T2DM-related neurocognitive changes, which extend from structural to functional and metabolite alterations in the brain. The evidence indicates various changes in the T2DM brain, including global and regional atrophy, white matter hyperintensity, altered functional connectivity, and changes in neurometabolite levels. Continued neuroimaging research is expected to further elucidate the underpinnings of cognitive decline in T2DM and allow better diagnosis and treatment of the condition.

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Endocrinol Metab : Endocrinology and Metabolism