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Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches

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Abstract


Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 15–25% of patients have a permanent IAH.

A recurrent hypoglycemia is a cornerstone in IAH formation. The repeated episodes of hypoglycemia impair neurohumoral response to hypoglycemia, reduce its symptoms and induce inadequate brain adaptation to low glucose levels. In this regard, the IAH phenomenon can be considered as an example of "metabolic memory" in diabetes.

The IAH is associated with episodes of severe hypoglycemia, fear of hypoglycemia and cognitive dysfunction. These associates can be combined into IAH syndrome. Development of IAH becomes a serious barrier in diabetes management.

A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. Structured training under specialized programs with psychological support is the most reasonable therapeutic approach to IAH amending. Technological approaches, including continuous subcutaneous insulin infusion, real-time continuous glucose monitoring, closed-loop insulin delivery systems ("artificial pancreas"), and islet transplantation also showed efficacy in hypoglycemia awareness improvement in some clinical studies.

The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.


Vadim V. Klimontov

Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences

Author for correspondence.
Email: klimontov@mail.ru
ORCID iD: 0000-0002-5407-8722
SPIN-code: 1734-4030

Russian Federation, 2, Timakov Street, Novosibirsk, 630060

MD, PhD, Professor

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Supplementary files

Supplementary Files Action
1. Fig. 1. Monthly trend of changes in glycemia with numerous episodes of hypoglycemia in a patient with type 1 diabetes with impaired recognition of hypoglycemia. View (532KB) Indexing metadata
2. Fig. 2. Scheme of the formation of the phenomenon of recognition of hypoglycemia in diabetes mellitus. View (862KB) Indexing metadata
3. Fig. 3. Permanent hyperglycemia in a patient with type 1 diabetes mellitus on the background of systematic underestimation of insulin doses due to fear of hypoglycemia. View (791KB) Indexing metadata

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