ArticleJournal of diabetes science and technology2010
Factors influencing the effectiveness of glucagon for preventing hypoglycemia.
Article in Journal of diabetes science and technology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
What it found
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The trial behind it
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Who cites it
23 citing papers in PubMed, 47 citations in OpenAlex.
- Efficacy of an Overnight Predictive Low-Glucose Suspend System in Relation to Hypoglycemia Risk Factors in Youth and Adults With Type 1 Diabetes.Journal of diabetes science and technology · 2016Trial
- Quantification of the glycemic response to microdoses of subcutaneous glucagon at varying insulin levels.Diabetes care · 2014Trial
- Closed-loop basal insulin delivery over 36 hours in adolescents with type 1 diabetes: randomized clinical trial.Diabetes care · 2013Trial
- Safety and efficacy of 24-h closed-loop insulin delivery in well-controlled pregnant women with type 1 diabetes: a randomized crossover case series.Diabetes care · 2011Trial
- A controlled study of the effectiveness of an adaptive closed-loop algorithm to minimize corticosteroid-induced stress hyperglycemia in type 1 diabetes.Journal of diabetes science and technology · 2011Trial
- The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control.Journal of endocrinological investigation · 2024Review
- Vasodilatory effects of glucagon: A possible new approach to enhanced subcutaneous insulin absorption in artificial pancreas devices.Frontiers in bioengineering and biotechnology · 2022Article
- Adjunctive Therapies to Optimize Closed-loop Glucose Control.Journal of diabetes science and technology · 2021Article
- Intraperitoneal and subcutaneous glucagon delivery in anaesthetized pigs: effects on circulating glucagon and glucose levels.Scientific reports · 2020Article
- Glucagon therapy in canines with an insulinoma: A retrospective descriptive study of 11 dogs.The Canadian veterinary journal = La revue veterinaire canadienne · 2020Article
- Role of Glucagon in Automated Insulin Delivery.Endocrinology and metabolism clinics of North America · 2020Review
- Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes.Endocrine reviews · 2019Review
- Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines.Nature reviews. Gastroenterology & hepatology · 2019Review
- Insulin-and-Glucagon Artificial Pancreas Versus Insulin-Alone Artificial Pancreas: A Short Review.Diabetes spectrum : a publication of the American Diabetes Association · 2019Article
- Intraperitoneal, subcutaneous and intravenous glucagon delivery and subsequent glucose response in rats: a randomized controlled crossover trial.BMJ open diabetes research & care · 2018Article
- A Review of Safety and Design Requirements of the Artificial Pancreas.Annals of biomedical engineering · 2016Review
- Glucagon responses to exercise-induced hypoglycaemia are improved by somatostatin receptor type 2 antagonism in a rat model of diabetes.Diabetologia · 2016Article
- Hypoglycemia unawareness prevention: Targeting glucagon production.Physiology & behavior · 2016Review
- Effect of Repeated Glucagon Doses on Hepatic Glycogen in Type 1 Diabetes: Implications for a Bihormonal Closed-Loop System.Diabetes care · 2015Article
- A review of artificial pancreas technologies with an emphasis on bi-hormonal therapy.Diabetes, obesity & metabolism · 2013Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAdministration of small, intermittent doses of glucagon during closed-loop insulin delivery markedly reduces the frequency of hypoglycemia. However, in some cases, hypoglycemia occurs despite administration of glucagon in this setting.
methodsFourteen adult subjects with type 1 diabetes participated in 22 closed-loop studies, duration 21.5±2.0 h. The majority of subjects completed two studies, one with insulin + glucagon, given subcutaneously by algorithm during impending hypoglycemia, and one with insulin+placebo. The more accurate of two subcutaneous glucose sensors was used as the controller input. To better understand reasons for success or failure of glucagon to prevent hypoglycemia, each response to a glucagon dose over 0.5 µg/kg was analyzed (n=19 episodes).
resultsHypoglycemia occurred in the hour after glucagon delivery in 37% of these episodes. In the failures, estimated insulin on board was significantly higher versus successes (5.8±0.5 versus 2.9±0.5 U, p<.001). Glucose at the time of glucagon delivery was significantly lower in failures versus successes (86±3 versus 95±3 mg/dl, p=.04). Sensor bias (glucose overestimation) was highly correlated with starting glucose (r=0.65, p=.002). Prior cumulative glucagon dose was not associated with success or failure.
conclusionGlucagon may fail to prevent hypoglycemia when insulin on board is high or when glucagon delivery is delayed due to overestimation of glucose by the sensor. Improvements in sensor accuracy and delivery of larger or earlier glucagon doses when insulin on board is high may further reduce the frequency of hypoglycemia.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.