Evidence map›Paper›PMID 25998294›Full record

ReviewDiabetes care2015

Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

Pratik Choudhary, Michael R Rickels, Peter A Senior, Marie-Christine Vantyghem, Paola Maffi, Thomas W Kay, Bart Keymeulen, Nobuya Inagaki, Frantisek Saudek, Roger Lehmann and 1 more

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Diabetes care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
88citing papers in PubMed, 3 pooled it
17.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

88 citing papers in PubMed, 3 syntheses or guidelines pooled it, 231 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Guideline
  4. Trial
  5. Cost-effectiveness of a Novel Hypoglycaemia Programme: The 'HARPdoc vs BGAT' RCT.Diabetic medicine : a journal of the British Diabetic Association · 2024
    Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Phase 3 trial of human islet-after-kidney transplantation in type 1 diabetes.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2021
    Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Review
  16. Article
  17. Article
  18. Article
  19. Review
  20. Article

28 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 10 institutions in 9 countries.

Pratik ChoudharyDiabetes Research Group, King's College London, London, U.K.
Michael R RickelsDepartment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Peter A SeniorDepartment of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Canada.
Marie-Christine VantyghemEndocrinology and Metabolism Department, INSERM U1190, European Genomics Institute for Diabetes, Lille University Hospital, Lille Cedex, France.
Paola MaffiDiabetes Research Institute, Scientific Institute Ospedale San Raffaele, Milan, Italy.
Thomas W KayImmunology and Diabetes Unit, St. Vincent's Institute, University of Melbourne, Melbourne, Australia.
Bart KeymeulenDiabetes Clinic and Research Center, Vrije Universiteit Brussel, Brussels, Belgium.
Nobuya InagakiDepartment of Diabetes and Clinical Nutrition, Kyoto University, Kyoto, Japan.
Frantisek SaudekDiabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Roger LehmannDepartment of Endocrinology and Diabetology, University of Zurich, Zurich, Switzerland.
Bernhard J HeringSchulze Diabetes Institute and Department of Surgery, University of Minnesota, Minneapolis, MN bhering@umn.edu.
European Genomic Institute for Diabetes · FRInstitute of Clinical and Experimental Medicine · CZIRCCS Ospedale San Raffaele · ITKyoto University · JPSt Vincents Institute of Medical Research · AUUniversity of Alberta · CAUniversity of Minnesota · USUniversity of Pennsylvania · USUniversity of Zurich · CHVrije Universiteit Brussel · BE

Funding

B-Lymphocyte Immunotherapy in Islet TransplantationU01DK070430 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI NAJI, ALI · 2004 to 2011
$10.1M
Advancing Islet Transplants for Type 1 Diabetes CareU01AI065193 · NIAID · UNIVERSITY OF MINNESOTA TWIN CITIES · PI HERING, BERNHARD JOSEF · 2004 to 2008
$9.3M
Alloantigen Delivery Via ECDI-Fixed Cells For Tolerance To Monkey Islet GraftsU01AI102463 · NIAID · UNIVERSITY OF MINNESOTA · PI HERING, BERNHARD JOSEF, LUO, XUNRONG · 2012 to 2016
$4.4M
Glucose Counterregulation in Long Standing Type 1 DiabetesR01DK091331 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI RICKELS, MICHAEL R · 2011 to 2020
$3.8M
NIAID NIH HHS U01 AI065193NIAID NIH HHS U01-AI-065193NIAID NIH HHS U01 AI102463NIAID NIH HHS U01-AI-102463NIDDK NIH HHS R01 DK091331NIDDK NIH HHS R01-DK-091331NIDDK NIH HHS U01 DK070430NIDDK NIH HHS U01-DK-070430
6 · The paper itself

Abstract

Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.

Indexed as

AlgorithmsAwarenessBlood GlucoseBlood Glucose Self-MonitoringDiabetes Mellitus, Type 1Evidence-Based MedicineHumansHypoglycemiaHypoglycemic AgentsInsulinInsulin Infusion SystemsPancreas TransplantationPatient Education as TopicBlood GlucoseHypoglycemic AgentsInsulin

Identifiers

PMID25998294
PMCPMC4439532
OpenAlexW1811184783

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.