What is the clinical evidence from this study?

Study design: RCT. Population: Healthy (n=20). Intervention: Clamped hypoglycemia (single and repeated episodes) vs. Euglycemia (hyperinsulinemic-euglycemic clamps). Primary outcome: Fibrinolytic balance, proinflammatory biomarkers, proatherothrombotic mechanisms, and endothelial function (p=<0.05).

What does this research mean for the field?

Single and repeated episodes of hypoglycemia increase proinflammatory and coagulation biomarkers and impair nitric oxide-mediated endothelial function in healthy individuals, with repeated episodes exacerbating these proatherothrombotic effects. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the effects of single versus repeated episodes of clamped hypoglycemia on endothelial function, proinflammatory biomarkers, and atherothrombotic balance in healthy individuals.

February 18, 2015DiabetesOpen Access

Effects of Acute and Antecedent Hypoglycemia on Endothelial Function and Markers of Atherothrombotic Balance in Healthy Humans

Q: What are the key findings of this study?

Single and repeated episodes of clamped hypoglycemia increased proinflammatory and coagulation biomarkers and impaired NO-mediated endothelial function compared with euglycemia (P<0.05).

Q: What does this research mean for the field?

Single and repeated episodes of hypoglycemia increase proinflammatory and coagulation biomarkers and impair nitric oxide-mediated endothelial function in healthy individuals, with repeated episodes exacerbating these proatherothrombotic effects. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the effects of single versus repeated episodes of clamped hypoglycemia on endothelial function, proinflammatory biomarkers, and atherothrombotic balance in healthy individuals.

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Key result

Single and repeated episodes of clamped hypoglycemia increased proinflammatory and coagulation biomarkers and impaired NO-mediated endothelial function compared with euglycemia (P<0.05).

Why the study?

Does antecedent hypoglycemia worsen endothelial function and atherothrombotic balance compared to a single acute episode of hypoglycemia in healthy individuals?

Population

20 healthy individuals (12 male and 8 female)

Comparison

Antecedent hypoglycemia vs Acute hypoglycemia

Design

RCT, randomized protocols

Follow-up

2 days

Authors

NJNino G. JoyPacira (United States)DTDonna B. TateUniversity of Baltimore LYLisa M. YounkButterworth Hospital

Discussion

Member takes

Implication

Antecedent hypoglycemia worsens endothelial dysfunction and proatherothrombotic state beyond single episodes; extends RCT evidence on hypoglycemia's CV effects in diabetes.

Key Points

To evaluate the effects of single versus repeated episodes of clamped hypoglycemia on endothelial function, proinflammatory biomarkers, and atherothrombotic balance in healthy individuals.
Conducted a randomized 2-day protocol in 20 healthy adults (12 male, 8 female).
Participants received two 2-hour hyperinsulinemic-euglycemic or hypoglycemic clamps on Day 1, followed by a single 2-hour hypoglycemic clamp on Day 2.
Brachial artery endothelial function was measured using two-dimensional Doppler ultrasound alongside circulating markers of inflammation, coagulation, and autonomic responses.
Single and repeated hypoglycemia significantly increased levels of PAI-1, VCAM-1, ICAM-1, E-selectin, P-selectin, TAT complex, TNF-α, and IL-6 compared to euglycemia (P < 0.05).
Repeated hypoglycemia significantly blunted neuroendocrine and autonomic nervous system responses while impairing both endogenous and exogenous nitric oxide-mediated vasodilation (P < 0.05).
Antecedent hypoglycemia produced greater vascular endothelial dysfunction and a heightened proatherothrombotic state compared to a single acute episode.

Study Design

Type

RCT (n=20)

Randomization

randomized

Structured PICO

Does antecedent hypoglycemia worsen endothelial function and atherothrombotic balance compared to a single acute episode of hypoglycemia in healthy individuals?

Population

20 healthy individuals (12 male and 8 female)

Intervention

Antecedent hypoglycemia (two 2-h hyperinsulinemic-hypoglycemic clamps on Day 1, followed by a single 2-h hyperinsulinemic-hypoglycemic clamp on Day 2)

Comparator

Acute hypoglycemia (two 2-h hyperinsulinemic-euglycemic clamps on Day 1, followed by a single 2-h hyperinsulinemic-hypoglycemic clamp on Day 2)

Outcome

Fibrinolytic balance, proinflammatory biomarkers, proatherothrombotic mechanisms, and endothelial function (measured via 2D Doppler ultrasound)surrogate

Main Result

p-value: p=<0.05

Antecedent hypoglycemia results in greater endothelial dysfunction and an increased proatherothrombotic state compared with a single acute episode of hypoglycemia.

Cite This Study

Joy et al. (2015) conducted an RCT in Healthy (n=20). Clamped hypoglycemia (single and repeated episodes) vs. Euglycemia (hyperinsulinemic-euglycemic clamps) was evaluated on Fibrinolytic balance, proinflammatory biomarkers, proatherothrombotic mechanisms, and endothelial function (p=<0.05). Single and repeated episodes of clamped hypoglycemia increased proinflammatory and coagulation biomarkers and impaired NO-mediated endothelial function compared with euglycemia (P<0.05).

synapsesocial.com/papers/6a16522b686acbfb79d96895 https://doi.org/10.2337/db14-1729

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Implication

Antecedent hypoglycemia worsens endothelial dysfunction and proatherothrombotic state beyond single episodes; extends RCT evidence on hypoglycemia's CV effects in diabetes.

Effects of Acute and Antecedent Hypoglycemia on Endothelial Function and Markers of Atherothrombotic Balance in Healthy Humans

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Effects of Acute and Antecedent Hypoglycemia on Endothelial Function and Markers of Atherothrombotic Balance in Healthy Humans

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider