Diabetic autonomic neuropathy does not impede improvement in hypoglycaemia awareness in adults: Sub-study results from the HypoCOMPaSS trial
Arshad, Muhammad F Walkinshaw, Emma Solomon, Alexanfra L Bernjak, Alan Rombach, Ines Leelarathna, Lala Little, Stuart A Evans, Mark Shaw, James A M Heller, Simon R
Arshad, Muhammad F
Walkinshaw, Emma
Solomon, Alexanfra L
Bernjak, Alan
Rombach, Ines
Leelarathna, Lala
Little, Stuart A
Evans, Mark
Shaw, James A M
Heller, Simon R
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Affiliation
University of Sheffield; Sheffield Teaching Hospitals NHS Foundation Trust; The Dudley Group NHS Foundation Tust et al
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Publication date
14/05/2024
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Abstract
Impaired awareness of hypoglycaemia (IAH) increases the risk of severe hypoglycaemia in people with type 1 diabetes mellitus (T1DM). IAH can be reversed through meticulous avoidance of hypoglycaemia. Diabetic autonomic neuropathy (DAN) has been proposed as an underlying mechanism contributing to IAH; however, data are inconsistent. The aim of this study was to examine the effects of cardiac autonomic neuropathy (CAN) on IAH reversibility inT1DM. Participants with T1DM and IAH (Gold score >=4) recruited to the HypoCOMPaSS (24-week 2 x 2 factorial randomised controlled) trial were included. All underwent screening for cardiac autonomic function testing at baseline and received comparable education and support aimed at avoiding hypoglycaemia and improving hypoglycaemia awareness. Definite CAN was defined as the presence of >=2 abnormal cardiac reflex tests. Participants were grouped according to their CAN status, and changes in Gold score were compared. Result(s): Eighty-three participants (52 women [62.7%]) were included with mean age (SD) of 48 (12) years and mean HbA1c of 66 (13) mmol/mol (8.2 [3.3] %). The mean duration of T1DM was 29 (13) years. The prevalence of CAN was low with 5/83 (6%) participants having definite autonomic neuropathy with 11 (13%) classified with possible/early neuropathy. All participants, regardless of the autonomic function status, showed a mean improvement in Gold score of >=1 (mean improvement -1.2 [95% CI -0.8, -1.6]; p < 0.001). IAH can be improved in people with T1DM, and a long duration of disease, with and without cardiac autonomic dysfunction. These data suggest that CAN is not a prime driver for modulating IAH reversibility.
Citation
Arshad MF, Walkinshaw E, Solomon AL, Bernjak A, Rombach I, Leelarathna L, Little SA, Evans M, Shaw JAM, Heller SR, Iqbal A. Diabetic autonomic neuropathy does not impede improvement in hypoglycaemia awareness in adults: Sub-study results from the HypoCOMPaSS trial. Diabet Med. 2024 Sep;41(9):e15340. doi: 10.1111/dme.15340. Epub 2024 May