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In addition, increases in both serum tissue plasminogen activator (tPA) and aldosterone, a hormone involved in vascular injury, have been reported under hypoglycaemic conditions, suggesting that hypoglycaemia drives endothelial dysfunction [ 14, 61].
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However, an important response driven by recurrent hypoglycaemia in T1D and advanced T2D involves the impairment of physiological mechanisms that normally defend against declining plasma glucose levels.
In conclusion, the islet transplantation outcomes from our single, nationally funded health centre in Scotland demonstrate that referrals and transplantations are predominantly from socioeconomically deprived groups with low employment and a decreased ability to drive secondary to their hypoglycaemia.
"Our study reveals a class of insulins that have evolved to act rapidly and potently to cause severe hypoglycaemia".
This was driven by the reduced effect of hypoglycaemia on quality of life offsetting the difference in incidence of complications.
This effect was driven by a significant increase in β2-adrenergic receptor sensitivity following hypoglycaemia compared with euglycaemia in ArgArg participants (p = 0.019), whereas no such effect was observed in the GlyGly participants.
The NICE guidance gives more weight to the health economic arguments that are driven primarily by reductions in HbA1c as opposed to reductions in rates of hypoglycaemia.
The progression of Type 2 diabetes is driven by progressive β-cell dysfunction and increased insulin resistance, which results in hypoglycaemia due to difficulty of achieving glycaemic control.
In addition, treatment satisfaction may be driven by the greater reductions in fasting glucose, HbA1c levels and less frequent hypoglycaemia with liraglutide treatment.
In the moderate RI category, the incidence of drug-related AEs was higher with linagliptin than with placebo, a finding which may have been driven by the high proportion of linagliptin subjects (7 of 10 subjects) who reported hypoglycaemia as a drug-related AE.
The risk of hypoglycaemia is increased in older patients, those with longer diabetes duration, lesser insulin reserve and perhaps in the drive for strict glycaemic control.
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CEO of Professional Science Editing for Scientists @ prosciediting.com