Moderator of 1 Session

Session Type
Parallel Session
Date
Thu, 28.04.2022
Session Time
13:00 - 14:30
Room
Hall 116

Presenter of 1 Presentation

Which is best at improving impaired awareness of hypoglycemia: Technology, insulins or training & Education

Session Type
Parallel Session
Date
Sat, 30.04.2022
Session Time
11:00 - 12:30
Room
Hall 113
Lecture Time
11:50 - 12:15

Abstract

Abstract Body

Impaired awareness is a major acquired complication of diabetes which affects around 25% and 10% of those with type 1 and type 2 diabetes respectively. Those developing impaired awareness have an increased risk of severe hypoglycaemic episodes as much as 6 times greater compared to those with normal awareness in some prospective studies. Studies in the 90s showed that a failure to recognise hypoglycaemia is due to an altered relationship between the glycaemic threshold for cognitive impairment and protective counterregulatory responses particularly sympathoadrenal activation. The latter both generates symptoms and opposes the glucose lowering effects of insulin through glycogenolysis. This led to the programmes of reversal of impaired awareness by avoidance of hypoglycaemia initially by intensive professional support and structured education and more recently by technologies including CGM and hybrid closed loop. These approaches have all proved useful but are not universally successful; for example, technology may reduce rates of hypoglycaemia without restoring normal awareness or impaired counterregulatory responses. Thus, hypoglycaemia remains a major factor preventing those on insulin and sulphonylureas from achieving recommended glucose targets. Those in the field continue to seek a greater understanding of the pathophysiological processes which lead to impaired awareness and risk of severe hypoglycaemia which may result in more successful targeted therapy.

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