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Potential approaches to prevent hypoglycemia-associated autonomic failure

Eric Lontchi-Yimagou1, Jee Young You1, Michelle Carey1,2

  • 1Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research
|November 17, 2017
PubMed

Insights

Intensive glucose control in type 1 diabetes mellitus (T1DM) is beneficial but risks severe hypoglycemia. Pharmacological strategies targeting mechanisms of hypoglycemia-associated autonomic failure (HAAF) show promise for preventing this complication.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Neuroscience

Background:

  • Intensive glycemic control in type 1 diabetes mellitus (T1DM) offers significant health benefits.
  • Severe hypoglycemia is a major barrier to achieving optimal glycemic control in T1DM.
  • Recurrent hypoglycemia can lead to hypoglycemia-associated autonomic failure (HAAF), impairing the body's response to low blood sugar.

Purpose of the Study:

  • To review pharmacological approaches for preventing hypoglycemia-associated autonomic failure (HAAF) in type 1 diabetes mellitus (T1DM).
  • To explore the underlying mechanisms of HAAF, including central, hormonal, and nutrient-related pathways.

Main Methods:

  • Literature review of studies investigating mechanisms of HAAF.
  • Analysis of pharmacological interventions targeting identified HAAF pathways.
  • Examination of the impact of various receptors, hormones, and nutrients on HAAF development.

Main Results:

  • HAAF involves complex central mechanisms (e.g., opioid, KATP, adrenergic receptors) and hormonal factors (e.g., cortisol, estrogen, GLP-1).
  • Nutrient-related factors like fructose, free fatty acids, and ketones also play a role in HAAF.
  • Multiple therapeutic targets and strategies have been identified in the literature.

Conclusions:

  • Pharmacological interventions targeting the diverse mechanisms of HAAF present promising avenues for preventing impaired counter-regulation in T1DM.
  • Addressing HAAF is crucial for enabling safer and more effective intensive glucose control in T1DM patients.
  • Further research into these pharmacological approaches may reduce a significant limitation to optimal glycemic management.
Keywords:
diabetes complicationsdiabetes mellitusdisease managementhypoglycemia

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