The data showed that patients who used diabetes techniques used different strategies to prevent nocturnal hypoglycemia compared to those who did not.
New research is providing insights into the strategies patients with type 1 diabetes (T1D) use to prevent hypoglycemia overnight, and how the techniques they use affect their approach.
Findings from more than 800 patients show that patients using diabetes technologies such as continuous subcutaneous insulin infusion (CSII), intermittent scanning continuous glucose monitor (isCGM), real-time CGM (rtCGM), and automated insulin delivery. AID), using different strategies to prevent nocturnal hypoglycemia (NH) compared to patients not using such techniques.
The findings appear in Diabetes Research and Clinical Practice.
Overall, the strategies patients used—including blood glucose monitoring at bedtime, snacking at night or before bedtime, and nighttime basal insulin reduction—conformed to current recommendations. For example, most patients monitor their blood sugar at bedtime. However, the researchers also found that the treatments they used and their level of fear of hypoglycemia (FOH) may have influenced their behavior.
“Current NH prevention strategies can be categorized as lifestyle, pharmacological or technical strategies,” the researchers describe. “The most consistently recommended lifestyle-related prevention strategy is the consumption of a bedtime snack containing carbohydrates and protein. When bedtime blood glucose is <7.0 mmol/L or in high-risk situations (ie, after drinking alcohol or engaging in physical activity in the evening) ), clinical recommendations mostly support bedtime snacks. However, there is little evidence to support these recommendations and their use by T1D patients [PWT1D] Not yet evaluated. "
Patients using CSII plus isCGM, CSII plus rtCGM, AID, or MDI plus rtCGM were less likely to prevent NH with a nighttime snack than patients using multiple daily injections (MDI) plus capillary blood glucose (CBG) (odds ratio). [OR]0.55, 0.40, 0.34 and 0.44).
When combined with other modalities, CSII use was significantly associated with a reduction in basal insulin throughout the night. When used with CBG (OR, 3.15), isCGM (OR, 4.00), and rtCGM (OR, 2.78), CSII increased the likelihood of reducing basal insulin compared with MDI plus CBG. Patients using CSII plus rtCGM were less likely to monitor blood glucose at bedtime than patients using MDI plus CBG.
Reducing alcohol consumption or reducing physical activity at the end of the day made no difference in treatment.
“Aside from treatment modality, the factor significantly associated with most of the strategies used was elevated FOH,” the researchers detailed. “Participants with elevated levels of fear were more likely to snack at night/before bedtime, avoid nighttime insulin injections, reduce/avoid alcohol consumption, and reduce/avoid physical activity. FOH is a significant barrier to optimal T1D management, as many PWT1D predispositions to maintain higher blood sugar levels to avoid the negative effects of experiencing hypoglycemia. This may have negative implications for diabetes management, as FOH has been found to be associated with higher caloric intake and greater glycemic variability and has been identified as a Significant barriers to participation in physical activity.”
The researchers noted that patients’ choice of strategy may have been the result of their recent episode of NH, although the current study was unable to characterize this. Their group also emphasizes that the role of diabetes technology in driving certain behaviors in T1D is uncertain. Therefore, they recommend future research to assess the different motivations for choosing strategies to prevent hypoglycemic episodes and how technology affects their behavior.
refer to
Talbo M, Rabasa-Lhoret R, Yale J, Peters T, Brazeau A. Does diabetes technology use affect nocturnal hypoglycemia prevention strategies? Better registry analysis. Diabetes Clinical Practice. Published online September 12, 2022. doi:10.1016/j.diabres.2022.110080