Current and future therapies to treat impaired awareness of hypoglycemia.
Current and future therapies to treat impaired awareness of hypoglycemia.
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DOI：
10.3389/fphar.2023.1271814
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发表时间：
2023
影响因子：
5.6
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中科院分区：
文献类型：
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为了实现最佳血糖控制，1型糖尿病（T1 D）和胰岛素依赖型2型糖尿病（T2 D）患者需要强化胰岛素方案。不幸的是，强化血糖控制常常导致胰岛素诱导的低血糖。此外，低血糖的反复发作导致与低血糖相关的特征性警告症状的丧失和减弱的反调节激素反应。警告症状的钝化被称为低血糖意识受损（IAH）。IAH和激素反应的丧失一起被称为低血糖相关的自主神经功能衰竭（HAAF）。IAH在T1 D患者中的患病率高达25%，在T2 D患者中高达10%。IAH和HAAF分别使严重低血糖的风险增加6倍和25倍。为了降低严重低血糖的风险，正在探索多种不同的治疗方法，以提高对低血糖的认识。目前提高低血糖意识的治疗方法包括患者教育和心理教育、使用新型血糖控制技术、胰腺/胰岛移植和药物治疗。本综述检查了现有的疗法和正在进行临床前试验的潜在疗法。通过改善反调节激素反应或改善低血糖症状识别来提高低血糖意识的新型治疗方法也将揭示导致IAH发展的可能神经机制。为了降低糖尿病患者发生严重低血糖的风险，阐明IAH背后的机制以及开发靶向治疗是目前IAH患者尚未满足的需求。
In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.
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DOI：
10.1111/dme.14789
发表时间：
2022-05
期刊：
Diabetic medicine : a journal of the British Diabetic Association
影响因子：
--
作者：
通讯作者：
--
影响因子：
3.5
作者：
Ali, Namam;El Hamdaoui, Soumia;de Galan, Bastiaan E.
通讯作者：
de Galan, Bastiaan E.
DOI：
10.1016/j.deman.2023.100136
发表时间：
2023-04-01
期刊：
DIABETES EPIDEMIOLOGY AND MANAGEMENT
影响因子：
--
作者：
Ang, Li Chang;Bee, Yong Mong;Teh, Ming Ming
通讯作者：
Teh, Ming Ming
影响因子：
7.7
作者：
Briscoe, Vanessa J.;Ertl, Andrew C.;Davis, Stephen N.
通讯作者：
Davis, Stephen N.
影响因子：
7.7
作者：
Carey, Michelle;Gospin, Rebekah;Hawkins, Meredith
通讯作者：
Hawkins, Meredith