3 years ago

Optimising the management of hypoglycaemia in people with Type 2 Diabetes. A randomised crossover comparison of a weight-based protocol compared with two fixed-dose glucose regimens

E Wiltshire, J.D Krebs, M Weatherall, L McTavish, B Corley
Aims To determine whether an individualised 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 12g or 30g glucose. Methods Adults with T2DM were enrolled into a cross-over study. Each episode of hypoglycaemia (capillary glucose <4.0mmol/L) was randomly assigned one of three treatment protocols: Either 0.3g/kg body-weight, 12g or 30g of glucose. 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 The mean (SD) age of the 30 participants was 68 (8.1) years, weight 91.5 (16.8)kg, and HbA1c 58.7 (9.2)mmol/mol. There were a total of 244 episodes of hypoglycaemia, ten 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 using a weight-based treatment compared to 12g was 3.2 (95% CI 1.1 to 9.0), P=0.009, for 30g and 12g treatment was 8.9 (95% CI 2.2 to 36.6), P<0.001 and for the weight-based compared with 30g treatment was 0.36 (95% CI 0.08 to 1.67) P=0.10. Conclusion In T2DM, either a weight-based 0.3g/kg, or a fixed 30g glucose treatment results in a higher blood glucose than a 12g treatment and increased probability of resolution of hypoglycaemia after 10 minutes. Both treatments result in an excess of mild rebound hyperglycaemia (>8mmol/L) at 30 minutes.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/dom.13231

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