Counterregulatory hormone and symptom responses to hypoglycaemia in people with type 1 diabetes, insulin-treated type 2 diabetes or without diabetes: the Hypo-RESOLVE hypoglycaemic clamp study

Fabricius, T.W. orcid.org/0000-0002-6344-5408, Verhulst, C.E.M. orcid.org/0000-0002-9905-7669, Kristensen, P.L. orcid.org/0000-0001-5431-824X et al. (7 more authors) (2024) Counterregulatory hormone and symptom responses to hypoglycaemia in people with type 1 diabetes, insulin-treated type 2 diabetes or without diabetes: the Hypo-RESOLVE hypoglycaemic clamp study. Acta Diabetologica. ISSN 0940-5429

Abstract

Aim

The sympathetic nervous and hormonal counterregulatory responses to hypoglycaemia differ between people with type 1 and type 2 diabetes and may change along the course of diabetes, but have not been directly compared. We aimed to compare counterregulatory hormone and symptom responses to hypoglycaemia between people with type 1 diabetes, insulin-treated type 2 diabetes and controls without diabetes, using a standardised hyperinsulinaemic-hypoglycaemic clamp.

Materials

We included 47 people with type 1 diabetes, 15 with insulin-treated type 2 diabetes, and 32 controls without diabetes. Controls were matched according to age and sex to the people with type 1 diabetes or with type 2 diabetes. All participants underwent a hyperinsulinaemic–euglycaemic-(5.2 ± 0.4 mmol/L)-hypoglycaemic-(2.8 ± 0.13 mmol/L)-clamp.

Results

The glucagon response was lower in people with type 1 diabetes (9.4 ± 0.8 pmol/L, 8.0 [7.0–10.0]) compared to type 2 diabetes (23.7 ± 3.7 pmol/L, 18.0 [12.0–28.0], p < 0.001) and controls (30.6 ± 4.7, 25.5 [17.8–35.8] pmol/L, p < 0.001). The adrenaline response was lower in type 1 diabetes (1.7 ± 0.2, 1.6 [1.3–5.2] nmol/L) compared to type 2 diabetes (3.4 ± 0.7, 2.6 [1.3–5.2] nmol/L, p = 0.001) and controls (2.7 ± 0.4, 2.8 [1.4–3.9] nmol/L, p = 0.012). Growth hormone was lower in people with type 2 diabetes than in type 1 diabetes, at baseline (3.4 ± 1.6 vs 7.7 ± 1.3 mU/L, p = 0.042) and during hypoglycaemia (24.7 ± 7.1 vs 62.4 ± 5.8 mU/L, p = 0.001). People with 1 diabetes had lower overall symptom responses than people with type 2 diabetes (45.3 ± 2.7 vs 58.7 ± 6.4, p = 0.018), driven by a lower neuroglycopenic score (27.4 ± 1.8 vs 36.7 ± 4.2, p = 0.012).

Conclusion

Acute counterregulatory hormone and symptom responses to experimental hypoglycaemia are lower in people with type 1 diabetes than in those with long-standing insulin-treated type 2 diabetes and controls.

Metadata

Item Type:

Article

Authors/Creators:

Fabricius, T.W. https://orcid.org/0000-0002-6344-5408
Verhulst, C.E.M. https://orcid.org/0000-0002-9905-7669
Kristensen, P.L. https://orcid.org/0000-0001-5431-824X
Holst, J.J. https://orcid.org/0000-0001-6853-3805
Tack, C.J. https://orcid.org/0000-0003-0322-1653
McCrimmon, R.J. https://orcid.org/0000-0002-3957-1981
Heller, S.R. https://orcid.org/0000-0002-2425-9565
Evans, M.L. https://orcid.org/0000-0001-8122-8987
de Galan, B.E. https://orcid.org/0000-0002-1255-7741
Pedersen-Bjergaard, U. https://orcid.org/0000-0003-0588-4880

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Keywords:

Counterregulatory response; Diabetes; Hyperinsulinaemic–hypoglycaemic clamp; Hypoglycaemia

Dates: