ArticleThe Journal of clinical endocrinology and metabolism2018
Continuous Glucose Monitoring for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes.
Article in The Journal of clinical endocrinology and metabolism, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Usability of Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Systematic Review.Diabetes technology & therapeutics · 2026Pooled it
- Effects of Continuous Glucose Monitoring on Impaired Awareness of Hypoglycemia in Older Adults With Type 1 Diabetes: A Post Hoc Analysis of the WISDM Study.Diabetes care · 2026Trial
- α- or β-Adrenergic blockade does not affect transplanted islet cell responses to hypoglycemia in type 1 diabetes.American journal of physiology. Endocrinology and metabolism · 2024Trial
- Evaluation of Clinical Metrics for Identifying Defective Physiologic Responses to Hypoglycemia in Long-Standing Type 1 Diabetes.Diabetes technology & therapeutics · 2022Trial
- 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 · 2021Trial
- Impaired Awareness and Symptomatology of Hypoglycemia in Adults With Type 1 Diabetes Using Continuous Glucose Monitoring.The Journal of clinical endocrinology and metabolism · 2025Article
- The challenge of assessing impaired awareness of hypoglycaemia in diabetes in the era of continuous glucose monitoring: A narrative review of evidence and translation into clinical practice.Diabetes, obesity & metabolism · 2025Review
- Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study.Diabetes care · 2025Article
- Glucose control and variability assessed by continuous glucose monitoring in patients with type 1 diabetes and diabetic kidney disease.Biomedical reports · 2025Article
- Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort.Diabetologia · 2025Article
- Interoceptive Awareness Is Associated With Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes.Diabetes care · 2025Article
- The impact of technology on impaired awareness of hypoglycaemia in type 1 diabetes.Therapeutic advances in endocrinology and metabolism · 2025Review
- The impact of closed-loop automated insulin delivery systems on hypoglycaemia awareness in people living with type 1 diabetes: A systematic review and meta-analysis.Journal of diabetes and metabolic disorders · 2024Article
- Mitigating Severe Hypoglycemia in Users of Advanced Diabetes Technologies: Impaired Awareness of Hypoglycemia and Unhelpful Hypoglycemia Beliefs as Targets for Interventions.Diabetes technology & therapeutics · 2024Article
- Effect of Impaired Awareness of Hypoglycemia on Glucose Decline During and After Exercise in the T1DEXI Study.The Journal of clinical endocrinology and metabolism · 2024Article
- Validating and Establishing a Diagnostic Threshold for the Hypoglycemia Awareness Questionnaire Impaired Awareness Subscale.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2023Article
- Automated Insulin Delivery for Hypoglycemia Avoidance and Glucose Counterregulation in Long-Standing Type 1 Diabetes with Hypoglycemia Unawareness.Diabetes technology & therapeutics · 2023Article
- Current and future therapies to treat impaired awareness of hypoglycemia.Frontiers in pharmacology · 2023Review
- Impaired Awareness of Hypoglycemia in Type 1 Diabetes: A Report of An NIDDK Workshop in October 2021.Diabetes care · 2022Review
- Autonomic dysfunction and risk of severe hypoglycemia among individuals with type 2 diabetes.JCI insight · 2022Article
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Authors and funding
10 authors.
Funding
Abstract
Context: Patients with long-standing type 1 diabetes (T1D) are at increased risk for severe hypoglycemia because of defects in glucose counterregulation and recognition of hypoglycemia symptoms, in part mediated through exposure to hypoglycemia. Objective: To determine whether implementation of real-time continuous glucose monitoring (CGM) as a strategy for hypoglycemia avoidance could improve glucose counterregulation in patients with long-standing T1D and hypoglycemia unawareness. Design, Setting, Participants, and Intervention: Eleven patients with T1D disease duration of ∼31 years were studied longitudinally in the Clinical & Translational Research Center of the University of Pennsylvania before and 6 and 18 months after initiation of CGM and were compared with 12 nondiabetic control participants. Main Outcome Measure: Endogenous glucose production response derived from paired hyperinsulinemic stepped-hypoglycemic and euglycemic clamps with infusion of 6,6-2H2-glucose. Results: In patients with T1D, hypoglycemia awareness (Clarke score) and severity (HYPO score and severe events) improved (P < 0.01 for all) without change in hemoglobin A1c (baseline, 7.2% ± 0.2%). In response to insulin-induced hypoglycemia, endogenous glucose production did not change from before to 6 months (0.42 ± 0.08 vs 0.54 ± 0.07 mg·kg-1·min-1) but improved after 18 months (0.84 ± 0.15 mg·kg-1·min-1; P < 0.05 vs before CGM), albeit remaining less than in controls (1.39 ± 0.11 mg·kg-1·min-1; P ≤ 0.01 vs all). Conclusions: Real-time CGM can improve awareness and reduce the burden of problematic hypoglycemia in patients with long-standing T1D, but with only modest improvement in the endogenous glucose production response that is required to prevent or correct low blood glucose.
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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.