Current and future therapies to treat impaired awareness of hypoglycemia

Frontiers in Pharmacology

Pharmacology

Mason Wooten¹  Lily A. Schoeder¹  Erica L. Macon¹  Andrea M. Woodcox¹  Colleen A. McMullen¹  Micah H. Devore¹  Simon J. Fisher¹  Zachary Beckner¹  Ashley N. Iles¹  Ashlee R. Marksbury¹  Megan B. Music¹  Bansi V. Patel¹  Yu Kuei Lin² 

[1] Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States;Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States;

关键词: impaired awareness;    hypoglycemia;    unawareness;    counterregulation;    diabetes;    insulin;   

DOI  :  10.3389/fphar.2023.1271814

 received in 2023-08-02, accepted in 2023-10-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

Unknown   
Copyright © 2023 Macon, Devore, Lin, Music, Wooten, McMullen, Woodcox, Marksbury, Beckner, Patel, Schoeder, Iles and Fisher.