Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches

Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15–25% of patients have a permanent IAH. A recurrent hypoglycemia is a corner...

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Autor principal:	Vadim V. Klimontov
Formato:	article
Lenguaje:	EN RU
Publicado:	Endocrinology Research Centre 2018
Materias:	diabetes hypoglycemia insulin brain glucose Nutritional diseases. Deficiency diseases RC620-627
Acceso en línea:	https://doaj.org/article/e32ac47ad9914153837ee287380fec78
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spelling	oai:doaj.org-article:e32ac47ad9914153837ee287380fec782021-11-14T09:00:22ZImpaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches2072-03512072-037810.14341/DM9597https://doaj.org/article/e32ac47ad9914153837ee287380fec782018-12-01T00:00:00Zhttps://www.dia-endojournals.ru/jour/article/view/9597https://doaj.org/toc/2072-0351https://doaj.org/toc/2072-0378Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15–25% of patients have a permanent IAH. A recurrent hypoglycemia is a cornerstone in IAH formation. The repeated episodes of hypoglycemia impair neurohumoral response to hypoglycemia, reduce its symptoms and induce inadequate brain adaptation to low glucose levels. In this regard, the IAH phenomenon can be considered as an example of "metabolic memory" in diabetes. The IAH is associated with episodes of severe hypoglycemia, fear of hypoglycemia and cognitive dysfunction. These associates can be combined into IAH syndrome. Development of IAH becomes a serious barrier in diabetes management. A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. Structured training under specialized programs with psychological support is the most reasonable therapeutic approach to IAH amending. Technological approaches, including continuous subcutaneous insulin infusion, real-time continuous glucose monitoring, closed-loop insulin delivery systems ("artificial pancreas"), and islet transplantation also showed efficacy in hypoglycemia awareness improvement in some clinical studies. The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.Vadim V. KlimontovEndocrinology Research CentrearticlediabeteshypoglycemiainsulinbrainglucoseNutritional diseases. Deficiency diseasesRC620-627ENRUСахарный диабет, Vol 21, Iss 6, Pp 513-523 (2018)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	diabetes hypoglycemia insulin brain glucose Nutritional diseases. Deficiency diseases RC620-627
spellingShingle	diabetes hypoglycemia insulin brain glucose Nutritional diseases. Deficiency diseases RC620-627 Vadim V. Klimontov Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
description	Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15–25% of patients have a permanent IAH. A recurrent hypoglycemia is a cornerstone in IAH formation. The repeated episodes of hypoglycemia impair neurohumoral response to hypoglycemia, reduce its symptoms and induce inadequate brain adaptation to low glucose levels. In this regard, the IAH phenomenon can be considered as an example of "metabolic memory" in diabetes. The IAH is associated with episodes of severe hypoglycemia, fear of hypoglycemia and cognitive dysfunction. These associates can be combined into IAH syndrome. Development of IAH becomes a serious barrier in diabetes management. A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. Structured training under specialized programs with psychological support is the most reasonable therapeutic approach to IAH amending. Technological approaches, including continuous subcutaneous insulin infusion, real-time continuous glucose monitoring, closed-loop insulin delivery systems ("artificial pancreas"), and islet transplantation also showed efficacy in hypoglycemia awareness improvement in some clinical studies. The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.
format	article
author	Vadim V. Klimontov
author_facet	Vadim V. Klimontov
author_sort	Vadim V. Klimontov
title	Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
title_short	Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
title_full	Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
title_fullStr	Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
title_full_unstemmed	Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
title_sort	impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
publisher	Endocrinology Research Centre
publishDate	2018
url	https://doaj.org/article/e32ac47ad9914153837ee287380fec78
work_keys_str_mv	AT vadimvklimontov impairedhypoglycemiaawarenessindiabetesepidemiologymechanismsandtherapeuticapproaches
_version_	1718429497712181248

Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches

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