Role of Glucagon in Automated Insulin Delivery

Overview

Journal Endocrinol Metab Clin North Am

Publisher Elsevier

Specialty Endocrinology

Date 2020 Jan 26

PMID 31980117

Citations 5

Authors

Leah M Wilson

Peter G Jacobs

Jessica R Castle

Affiliations

Soon will be listed here.

Abstract

Treatment of type 1 diabetes with exogenous insulin often results in unpredictable daily glucose variability and hypoglycemia, which can be dangerous. Automated insulin delivery systems can improve glucose control while reducing burden for people with diabetes. One approach to improve treatment outcomes is to incorporate the counter-regulatory hormone glucagon into the automated delivery system to help prevent the hypoglycemia that can be induced by the slow pharmacodynamics of insulin action. This article explores the advantages and disadvantages of incorporating glucagon into dual-hormone automated hormone delivery systems.

Citing Articles

Type 1 diabetes - What's new in prevention and therapeutic strategies?.

Pilsniak A, Otto-Buczkowska E Pediatr Endocrinol Diabetes Metab. 2023; 29(3):196-201.

PMID: 38031834 PMC: 10679919. DOI: 10.5114/pedm.2023.132028.

Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series.

Daly A, Hartnell S, Boughton C, Evans M J Diabetes Sci Technol. 2021; 15(6):1216-1223.

PMID: 34378426 PMC: 8564229. DOI: 10.1177/19322968211035447.

Fault Tolerant Strategies for Automated Insulin Delivery Considering the Human Component: Current and Future Perspectives.

Beneyto A, Bequette B, Vehi J J Diabetes Sci Technol. 2021; 15(6):1224-1231.

PMID: 34286613 PMC: 8655284. DOI: 10.1177/19322968211029297.

Dual-hormone artificial pancreas for management of type 1 diabetes: Recent progress and future directions.

Infante M, Baidal D, Rickels M, Fabbri A, Skyler J, Alejandro R Artif Organs. 2021; 45(9):968-986.

PMID: 34263961 PMC: 9059950. DOI: 10.1111/aor.14023.

Algorithms for Automated Insulin Delivery: An Overview.

Thomas A, Heinemann L J Diabetes Sci Technol. 2021; 16(5):1228-1238.

PMID: 33955251 PMC: 9445345. DOI: 10.1177/19322968211008442.

References

. Hypoglycemia in the Diabetes Control and Complications Trial. The Diabetes Control and Complications Trial Research Group. Diabetes. 1997; 46(2):271-86. View

Ranjan A, Schmidt S, Madsbad S, Holst J, Norgaard K . Effects of subcutaneous, low-dose glucagon on insulin-induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes. Diabetes Obes Metab. 2016; 18(4):410-8. DOI: 10.1111/dom.12627. View

El-Khatib F, Russell S, Nathan D, Sutherlin R, Damiano E . A bihormonal closed-loop artificial pancreas for type 1 diabetes. Sci Transl Med. 2010; 2(27):27ra27. PMC: 4242106. DOI: 10.1126/scitranslmed.3000619. View

Miller K, Foster N, Beck R, Bergenstal R, DuBose S, DiMeglio L . Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care. 2015; 38(6):971-8. DOI: 10.2337/dc15-0078. View

Youssef J, Castle J, Bakhtiani P, Haidar A, Branigan D, Breen M . Quantification of the glycemic response to microdoses of subcutaneous glucagon at varying insulin levels. Diabetes Care. 2014; 37(11):3054-60. PMC: 4207205. DOI: 10.2337/dc14-0803. View

Kishore P, Gabriely I, Cui M, Di Vito J, Gajavelli S, Hwang J . Role of hepatic glycogen breakdown in defective counterregulation of hypoglycemia in intensively treated type 1 diabetes. Diabetes. 2006; 55(3):659-66. DOI: 10.2337/diabetes.55.03.06.db05-0849. View

Gingras V, Taleb N, Roy-Fleming A, Legault L, Rabasa-Lhoret R . The challenges of achieving postprandial glucose control using closed-loop systems in patients with type 1 diabetes. Diabetes Obes Metab. 2017; 20(2):245-256. PMC: 5810921. DOI: 10.1111/dom.13052. View

Abitbol A, Rabasa-Lhoret R, Messier V, Legault L, Smaoui M, Cohen N . Overnight Glucose Control with Dual- and Single-Hormone Artificial Pancreas in Type 1 Diabetes with Hypoglycemia Unawareness: A Randomized Controlled Trial. Diabetes Technol Ther. 2018; 20(3):189-196. DOI: 10.1089/dia.2017.0353. View

Dagogo-Jack S, Rattarasarn C, Cryer P . Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Diabetes. 1994; 43(12):1426-34. DOI: 10.2337/diab.43.12.1426. View

10.

Camacho R, Galassetti P, Davis S, Wasserman D . Glucoregulation during and after exercise in health and insulin-dependent diabetes. Exerc Sport Sci Rev. 2005; 33(1):17-23. View

11.

Castle J, Engle J, Youssef J, Massoud R, Yuen K, Kagan R . Novel use of glucagon in a closed-loop system for prevention of hypoglycemia in type 1 diabetes. Diabetes Care. 2010; 33(6):1282-7. PMC: 2875438. DOI: 10.2337/dc09-2254. View

12.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

13.

Russell S, Hillard M, Balliro C, Magyar K, Selagamsetty R, Sinha M . Day and night glycaemic control with a bionic pancreas versus conventional insulin pump therapy in preadolescent children with type 1 diabetes: a randomised crossover trial. Lancet Diabetes Endocrinol. 2016; 4(3):233-243. PMC: 4799495. DOI: 10.1016/S2213-8587(15)00489-1. View

14.

Ryan G, Briscoe T, Jobe L . Review of pramlintide as adjunctive therapy in treatment of type 1 and type 2 diabetes. Drug Des Devel Ther. 2009; 2:203-14. PMC: 2761191. DOI: 10.2147/dddt.s3225. View

15.

Ranjan A, Norgaard K, Tetzschner R, Steineck I, Clausen T, Holst J . Effects of Preceding Ethanol Intake on Glucose Response to Low-Dose Glucagon in Individuals With Type 1 Diabetes: A Randomized, Placebo-Controlled, Crossover Study. Diabetes Care. 2018; 41(4):797-806. DOI: 10.2337/dc17-1458. View

16.

Cryer P, Davis S, Shamoon H . Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6):1902-12. DOI: 10.2337/diacare.26.6.1902. View

17.

Rickels M, DuBose S, Toschi E, Beck R, Verdejo A, Wolpert H . Mini-Dose Glucagon as a Novel Approach to Prevent Exercise-Induced Hypoglycemia in Type 1 Diabetes. Diabetes Care. 2018; 41(9):1909-1916. PMC: 6463733. DOI: 10.2337/dc18-0051. View

18.

Schmitz O, Brock B, Rungby J . Amylin agonists: a novel approach in the treatment of diabetes. Diabetes. 2004; 53 Suppl 3:S233-8. DOI: 10.2337/diabetes.53.suppl_3.s233. View

19.

Ranjan A, Schmidt S, Damm-Frydenberg C, Steineck I, Clausen T, Holst J . Low-Carbohydrate Diet Impairs the Effect of Glucagon in the Treatment of Insulin-Induced Mild Hypoglycemia: A Randomized Crossover Study. Diabetes Care. 2016; 40(1):132-135. DOI: 10.2337/dc16-1472. View

20.

Kerr D, MacDonald I, Heller S, Tattersall R . Alcohol causes hypoglycaemic unawareness in healthy volunteers and patients with type 1 (insulin-dependent) diabetes. Diabetologia. 1990; 33(4):216-21. DOI: 10.1007/BF00404799. View