Mini-dose glucagon may prevent exercise-associated hypoglycemia in patients with type 1 diabetes

Glucagon is the standard of care for hypoglycaemia treatment. Ronnie Aronson from LMC Diabetes & Endocrinology in Toronto, Ontario, Canada, and colleagues aimed to determine the effect of ready-to-use, mini-dose glucagon on the incidence of exercise-associated hypoglycemia in adults with type 1 diabetes.

The patients initially participated in the in-clinic training phase for which they were randomly allocated to 150 µg glucagon labelled as treatment arm A or placebo labelled as arm B subcutaneously in a crossover design immediately before exercise, plus a 50% reduction in continuous SC insulin infusion basal delivery rate. Then the completers were randomly assigned in the outpatient investigational phase of 12 weeks: arm A, B, or open-label C, 150 µg glucagon alone.

The patients, in real-world settings, performed their usual aerobic exercise with moderate to high intensity for 30 to 75 min. Data analysis was done for the level 1 hypoglycemia incidence based on self-monitoring blood glucose and several exploratory and secondary endpoints.

The authors reported the following findings:

• Forty-five continued to the outpatient phase out of 48 participants who completed the training phase.
• Level 1 hypoglycemia incidence for all exercise sessions in the outpatient phase (n = 795) was lower in both glucagon arms (A, 12%; C, 16%) versus the placebo arm (B, 39%).
• Among treatment arms, times in range, below range, and above range from 0 to 300 min did not remarkably differ.
• With glucagon use, consumed grams of exercise carbohydrates were lower than placebo but did not reach statistical significance.
• Adverse events were comparable among treatment arms.

"In adults with type 1 diabetes, mini-dose glucagon with or without a 50% reduction in CSII basal delivery rate may help to decrease the incidence of exercise-associated hypoglycemia," the researchers concluded.

Reference:

Ronnie Aronson, Michael C. Riddell, Valentina Conoscenti, M. Khaled Junaidi; Effect of Mini-Dose Ready-to-Use Liquid Glucagon on Preventing Exercise-Associated Hypoglycemia in Adults With Type 1 Diabetes. Diabetes Care 2023; dc221145. https://doi.org/10.2337/dc22-1145