Terbutaline may be a safe and effective treatment option for prevention of nocturnal hypoglycemia in patients with type 1 diabetes.wisepoqder Terbutaline
Researchers of a randomized, controlled trial examined whether terbutaline prevented nocturnal hypoglycemia without causing morning hyperglycemia in 15 patients with type 1 diabetes.
Patients randomly assigned to 2.5 mg terbutaline (Brethine, Novartis) had a mean nadir nocturnal plasma glucose concentration of 100 mg/dL compared with 122 mg/dL with 5 mg terbutaline and 87 mg/dL with placebo (see chart). In the 2.5-mg terbutaline group, seven patients reached nadir nocturnal concentrations <70 mg/dL, six reached concentrations <60 mg/dL and two reached concentrations <50 mg/dL. Further, three patients assigned to 5-mg terbutaline reached nadir levels <70 mg/dL; none of these patients reached any level lower than that.
Morning plasma glucose levels were 127 mg/dL with 2.5 mg terbutaline, 183 mg/dL with 5 mg terbutaline and 113 mg/dL with placebo.
"These
data confirm a high frequency of nocturnal hypoglycemia in patients
with aggressively treated type 1 diabetes. These data also confirm that
bedtime administration of 5 mg terbutaline effectively prevents
nocturnal hypoglycemia," the researchers wrote.
Hypoglycemia
is the limiting step to glycemic control in patients with diabetes. It
can be serious and is occasionally fatal. The majority of hypoglycemic
episodes occur at night. Therefore, efforts to reduce the risk of
nocturnal hypoglycemia would be well directed. The group of Cryer et al
at Washington University have made a life career of addressing the
biology of hypoglycemia. This report is a follow-up of earlier work from
the same laboratory showing a beneficial effect of terbutaline (5 mg)
in decreasing hypoglycemia overnight, but that dose was associated with
undesirable hyperglycemia in the morning. The current study tested a
smaller dose (2.5 mg) of terbutaline and seems to have nailed the matter
squarely. It seems, therefore, that terbutaline can be added to other
existing strategies for reduction of nocturnal hypoglycemia. These other
strategies include bedtime caloric supply, recalibration of
antidiabetic medications, limitation of alcohol intake, exercise
counseling, self-blood glucose monitoring (especially in the ‘wee'
hours), prompt recognition and intervention for hypoglycemia
unawareness, among others. The fact that the study included just 15
patients with type 1 diabetes is an obvious limitation. Therefore, a
larger study expanded to even patients with type 2 diabetes (many of
whom are also at risk for hypoglycemia) would be most welcome.
By | buzai232 |
Added | Nov 7 '19, 07:45AM |
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