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17-03-2022 | Diabetes | News | Article

Mini-dose glucagon better than glucose tablets for Ramadan hypoglycemia

Author: Eleanor McDermid

medwireNews: Subcutaneous mini-dose glucagon reverses hypoglycemia more effectively than oral glucose tablets and helps adults with type 1 diabetes complete Ramadan fasts, shows a randomized crossover trial.

The 17 trial participants used mini-dose glucagon to treat or prevent hypoglycemia for 2 weeks during Ramadan and oral glucose tablets for another 2 weeks, with these two periods occurring in a randomly assigned order.

If blood glucose fell to 50–69 mg/dL (2.8–3.8 mmol/L), the participants used 150 µg of glucagon, reconstituted with water and injected with a standard insulin syringe, or 15 g of oral glucose; these doses were doubled if blood glucose fell to 40–49 mg/dL (2.2–2.7 mmol/L).

The trial’s primary endpoint was the change in glucose levels during the first 30 minutes after treatment. This was significantly greater after glucagon than glucose treatment, at an average of 65.3 versus 44.3 mg/dL (3.6 vs 2.5 mmol/L).

The researchers, led by Metab Algeffari (Qassim University, Buraydah, Saudi Arabia) and Sufyan Hussain (King’s College London, UK), say the pharmacokinetic response to glucagon was similar to than in previous studies, suggesting that its efficacy “is not affected by prolonged, repetitive fasting.”

Treatment success from the first dose was 100% for mini-dose glucagon and 84% for the oral glucose tablets, and the participants managed to complete all their fast days during the glucagon period compared with 88% during the glucose period.

They also had a significantly higher time in target blood glucose range (70–180 mg/dL, 3.9–10.0 mmol/L) during the glucagon versus glucose trial periods, at 61.0% versus 55.1%.

Six people reported nausea and injection site reactions related to glucagon treatment, with one reporting intolerable nausea.

Writing in Diabetes Care, the researchers note that there are potential improvements available to make glucagon a more appealing alternative to glucose for people with diabetes, such as the development of a reusable injection pen or use of an inhaled version, although they caution this latter option “can cause local adverse effects.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2022; doi:10.2337/dc21-1655