Again, while a number of continuous glucose monitoring (CGM)-based studies have reported that patients with type 1 diabetes are often susceptible to nocturnal hypoglycemia, asymptomatic episodes of nocturnal hypoglycemia are difficult to capture because they occur without the use of a CGM, which is not readily available for routine use in an outpatient setting. Given these considerations, it is clear that attention needs to be focused on improving HbA1c while simultaneously minimizing the occurrence of hypoglycemia in order to help patients maintain their QOL and lifespan. Otherwise, serious hypoglycemia is shown to significantly increase the risk for mortality among patients with type 1 and type 2 diabetes alike, irrespective of their history of cardiovascular disease. Again, frequent hypoglycemic episodes are associated with a significantly increased risk for mortality among patients with type 1 diabetes who have a history of cardiovascular disease. More importantly, the onset of nocturnal hypoglycemia is reported to lead to sympathetic nerve activation, followed by excessive compensatory vagal activation, resulting in bradycardia and life-threatening arrhythmia. Indeed, serious hypoglycemia is thought to be associated with sudden death or the “Dead in Bed” syndrome, where hypoglycemia is assumed to adversely affect the cardiovascular system, thus inducing arrhythmia or QT prolongation. Hypoglycemia is reported to account for 2% to 4% of all deaths among patients with type 1 diabetes, and can even be as high as 6% to 13% according to some reports. Indeed, the frequency of hypoglycemia showed a three-fold increase among those assigned to tight glycemic control in the DCCT/EDIC study. This is likely due to the increased risk of hypoglycemia associated with tight glycemic control aimed at lowering HbA1c. However, “the lower the HbA1c, the better the prognosis” does not necessarily apply to patients with type 1 diabetes, who are reportedly at a greater (rather than smaller) risk of all-cause and cardiovascular mortality even when their HbA1c values are controlled to 6.9% or lower. The DCCT/EDIC study, a large-scale clinical study on patients with type 1 diabetes, has clearly demonstrated that tight glycemic control through intensive insulin therapy significantly reduces the onset and progression of diabetic complications. The aims of diabetes treatment are preventing the onset and progression of diabetic complications through glycemic and metabolic control and maintaining quality of life (QOL) and lifespan for affected individuals.
However, these does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare to have no conflict of interest. Kazunori Utsunomiya has received research support from Kowa, Kyowa Kirin, MSD, Ono and Tanabe-Mitsubishi, and has participated in speaker's bureau/advisory panels for Astellas, Astra Zeneca, Kowa, MSD, Novo Nordisk and Sanofi. Daisuke Tsujino has participated in speaker's bureau/advisory panels for Novo Nordisk, and has received research support from Boehringer Ingelheim, and Takeda. Kiyotaka Ando has participated in speaker's bureau/advisory panels for Novo Nordisk and Sanofi. Rimei Nishimura has participated in speaker's bureau/advisory panels for Astellas, Astra Zeneca, Boehringer Ingelheim, Daiichi-Sankyo, Eli Lilly, Johnson & Johnson, Kissei, Kowa, Medtronic, Novo Nordisk, Ono, Sanofi, Taisho, Takeda and Tanabe Mitsubishi, and served as a consultant for Abbott, Boehringer Ingelheim, Eli Lilly, and Taisho. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information file.įunding: The authors received no specific funding for this work.Ĭompeting interests: Dr. Received: JanuAccepted: ApPublished: July 6, 2017Ĭopyright: © 2017 Takahashi et al. Atkin, Weill Cornell Medical College Qatar, QATAR Citation: Takahashi H, Nishimura R, Onda Y, Ando K, Tsujino D, Utsunomiya K (2017) Prediction of nocturnal hypoglycemia unawareness by fasting glucose levels or post-breakfast glucose fluctuations in patients with type 1 diabetes receiving insulin degludec: A pilot study.
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