Transcript Document 7904702

Hypoglycemia and Type 2 Diabetes
3x3x5
Mark R. Burge, M.D.
Professor of Medicine
Endocrinology and Metabolism
The University of New Mexico School of Medicine
Albuquerque, New Mexico
Background
Goal: To identify mechanisms, treatment, & preventative
strategies for hypoglycemia in type 2 diabetes.
Phase 1 translational research (aka “clinical research”).
Rate of severe events vary: 60-170 per year.
Hospitalizations cost between $200M - $1B per year.
Retrospective studies identify age, fasting, sulfonylurea
usage, polypharmacy, and intercurrent illness as risk
factors for severe hypoglycemia.
A Prospective Study of Risk factors for
Hypoglycemia in Type 2 Diabetes
80
Plasma Glucose (mg/dl)
Placebo Glucose
200
150
70
Max Dose Sulf Epi
60
50
Max Dose
Sulf Glucose
40
100
30
Placebo Epi
20
50
10
N = 52
0
0
14
15
16
17
18
19
20
Hours of Fasting
21
22
23
Plasma Epinephrine (mcg/ml)
250
What is the Role of Low Dose Ethanol in the
Pathogenesis of Hypoglycemia in T2DM?
Plasma Glucose (mg/dl)
175
N = 10
150
125
Placebo Study
100
Ethanol Study
75
50
p < 0.01
25
0
14
15
16
17
18
19
20
21
Hours of Study
22
23
24
1600
N = 10
1200
800
1600
Glucose Threshold = 83 ± 4 mg/dl
400
0
40
60
80
100
120
140
160
180
200
Day 2 Glucose (mg/dl)
220
240
Day 8 Epinephrine (pg/ml)
Day 2 Epinephrine (pg/ml)
Effect of Improved Diabetes Control on
Hypoglycemia Response in Elderly T2 DM
1200
800
Glucose Threshold = 61 ± 2 mg/dl
400
0
40
60
80
100
120
140
160
180
Day 8 Glucose (mg/dl)
200
220
240
Ethanol Differentially Effects Recovery from
Hypoglycemia in Non- DM and T2DM Subjects
100
Placebo
75
Ethanol
50
T2DM
25
N = 14, p = 0.68
0
0
1
2
Hours of Study
3
Plasma Glucose (mg/dl)
Plasma Glucose (mg/dl)
Nondiabetic
100
Placebo
75
Ethanol
50
25
N = 11; p < 0.01
0
0
1
2
Hours of Study
3