SynthesisDiabetologia2022
Glycaemic thresholds for counterregulatory hormone and symptom responses to hypoglycaemia in people with and without type 1 diabetes: a systematic review.
Synthesis in Diabetologia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia.Frontiers in endocrinology · 2024Pooled it
- [Diabetes mellitus and road traffic-A position paper of the Austrian Diabetes Association (Update 2026)].Wiener klinische Wochenschrift · 2026Article
- Carbohydrate Ingestion on Exercise Metabolism and Physical Performance.Endocrine reviews · 2026Review
- Article
- The roles, mechanisms, and therapeutic implications of glucocorticoids in glucose and lipid metabolism.Military Medical Research · 2026Review
- Dose-response relationship between the postload-fasting gap and the risk of developing diabetes: a cohort study from multiple centers in China.BMJ open diabetes research & care · 2025Article
- Hypothalamic Prostaglandins Facilitate Recovery From Severe Hypoglycemia but Exacerbate Recurrent Hypoglycemia in Mice.Diabetes · 2025Article
- Impaired Awareness and Symptomatology of Hypoglycemia in Adults With Type 1 Diabetes Using Continuous Glucose Monitoring.The Journal of clinical endocrinology and metabolism · 2025Article
- Article
- 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
- Associations between clustering of hypoglycemic symptoms, psychological traits, and problem-solving abilities in adults with type 1 diabetes: baseline data analysis of the PR-IAH study.Diabetology international · 2025Article
- An elevated triglyceride-glucose index in the first-trimester predicts adverse pregnancy outcomes: a retrospective cohort study.Archives of gynecology and obstetrics · 2025Article
- Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort.Diabetologia · 2025Article
- Changes of the cardiac electrical cycle in type 1 diabetes during hypoglycaemia - a prospective observational study.Frontiers in endocrinology · 2025Observational
- Exploring histone deacetylases in type 2 diabetes mellitus: pathophysiological insights and therapeutic avenues.Clinical epigenetics · 2024Review
- Article
- Evaluating the effectiveness of a novel somatostatin receptor 2 antagonist, ZT-01, for hypoglycemia prevention in a rodent model of type 2 diabetes.Frontiers in pharmacology · 2024Article
- [Diabetes mellitus and road traffic-a position paper of the Austrian Diabetes Association (update 2023)].Wiener klinische Wochenschrift · 2023Article
Corrections and comments
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Authors and funding
12 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aim/hypothesisThe physiological counterregulatory response to hypoglycaemia is reported to be organised hierarchically, with hormone responses usually preceding symptomatic awareness and autonomic responses preceding neuroglycopenic responses. To compare thresholds for activation of these responses more accurately between people with or without type 1 diabetes, we performed a systematic review on stepped hyperinsulinaemic-hypoglycaemic glucose clamps.
methodsA literature search in PubMed and EMBASE was conducted. We included articles published between 1980 and 2018 involving hyperinsulinaemic stepped hypoglycaemic glucose clamps among people with or without type 1 diabetes. Key exclusion criteria were as follows: data were previously published; other patient population; a clamp not the primary intervention; and an inadequate clamp description. Glycaemic thresholds for counterregulatory hormone and/or symptom responses to hypoglycaemia were estimated and compared using generalised logrank test for interval-censored data, where the intervals were either extracted directly or calculated from the data provided by the study. A glycaemic threshold was defined as the glucose level at which the response exceeded the 95% CI of the mean baseline measurement or euglycaemic control clamp. Because of the use of interval-censored data, we described thresholds using median and IQR.
resultsA total of 63 articles were included, whereof 37 papers included participants with type 1 diabetes (n=559; 67.4% male sex, aged 32.7±10.2 years, BMI 23.8±1.4 kg/m CONCLUSIONS/
interpretationPeople with type 1 diabetes have glycaemic thresholds for counterregulatory hormone and symptom responses at lower glucose levels than people without diabetes. Autonomic and neuroglycopenic symptoms responses are generated at about similar levels of hypoglycaemia. There was a considerable variation in the methodology of the articles and the high insulin doses in most of the clamps may affect the counterregulatory responses.
fundingThis article has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement no. 777460. REGISTRATION: This systematic review is registered in PROSPERO (CRD42019120083).
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