Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.
Diabetes Obes Metab. 2024 Sep;26(9):3696-3704. doi: 10.1111/dom.15712. Epub 2024 Jun 20.
To determine whether recent repeated exposure to real-life hypoglycaemia affects the pro-inflammatory response during a hypoglycemia episode.
This was a post hoc analysis of a hyperinsulinaemic normoglycaemic-hypoglycaemic clamp study, involving 40 participants with type 1 diabetes. Glucose levels 1 week before the clamp were monitored using a Freestyle Libre 1. Blood was drawn during normoglycaemia and hypoglycaemia, and 24 hours after resolution of hypoglycaemia for measurements of inflammatory responses and counterregulatory hormone levels. We determined the relationship between the frequency and duration of spontaneous hypoglycaemia, and time below range (TBR) and the inflammatory response to experimental hypoglycaemia.
On average, participants experienced 0.79 (0.43, 1.14) hypoglycaemia episodes per day, with a duration of 78 (47, 110) minutes and TBR of 5.5% (2.8%, 8.5%). TBR and hypoglycaemia frequency were inversely associated with the increase in circulating granulocyte and lymphocyte counts during experimental hypoglycaemia (P < .05 for all). A protein network consisting of DNER, IF-R, uPA, Flt3L, FGF-5 and TWEAK was negatively associated with hypoglycaemia frequency (P < .05), but not with the adrenaline response. Neither other counterregulatory hormones, nor hypoglycaemia awareness status, was associated with any of the inflammatory parameters markers.
Repeated exposure to spontaneous hypoglycaemia is associated with blunted effects of subsequent experimental hypoglycaemia on circulating immune cells and the number of inflammatory proteins.
确定近期反复发生的真实低血糖事件是否会影响低血糖发作期间的促炎反应。
这是一项高胰岛素正常血糖-低血糖钳夹研究的事后分析，涉及 40 名 1 型糖尿病患者。使用 Freestyle Libre 1 监测钳夹前 1 周的血糖水平。在正常血糖和低血糖期间采血，并在低血糖缓解后 24 小时测量炎症反应和代偿激素水平。我们确定了自发性低血糖的频率和持续时间以及血糖低于目标范围（TBR）与实验性低血糖对炎症反应的关系。
平均而言，参与者每天经历 0.79（0.43，1.14）次低血糖发作，持续时间为 78（47，110）分钟，TBR 为 5.5%（2.8%，8.5%）。TBR 和低血糖发作频率与实验性低血糖期间循环粒细胞和淋巴细胞计数的增加呈负相关（所有 P<0.05）。由 DNER、IF-R、uPA、Flt3L、FGF-5 和 TWEAK 组成的蛋白质网络与低血糖发作频率呈负相关（所有 P<0.05），但与肾上腺素反应无关。其他代偿激素，以及低血糖意识状态，均与任何炎症参数标志物无关。
反复发生自发性低血糖与随后的实验性低血糖对循环免疫细胞和炎症蛋白数量的影响减弱有关。
