HypoAwARE: Hypo Awareness restoration& Assoc Regional cerebral Effects
Research type
Research Study
Full title
Understanding cerebral responses to hypoglycaemia: a pathway to effective strategies to treat impaired awareness of hypoglycaemia in type 1 diabetes.
IRAS ID
138780
Contact name
Pratik Choudhary
Contact email
Research summary
Hypoglycaemia (low blood sugar) is the main complication of insulin therapy for type 1 diabetes mellitus (TIDM). In the standard hypoglycaemia aware [HA] state, the body responds to hypoglycaemia by producing hormones that help restore blood glucose to normal. Characteristic symptoms develop which enable patients to recognise hypoglycaemia and treat appropriately.
Recurrent hypoglycaemia, as seen in up to 40% of patients with long standing T1DM, blunts these hormonal and symptom responses, leading to impaired awareness of hypoglycaemia (IAH). IAH is associated with increased severe hypoglycaemia (episodes requiring help from someone else), which has a negative impact on employment, driving and quality of life. There is evidence that hypoglycaemia awareness can be restored in the research setting by strict hypoglycaemia avoidance.
Previous research showed reduced activation in brain regions involved with stress, symptom perception, aversion and food-seeking during hypoglycaemia in IAH patients compared to HA. This matches clinical observations of low concern for hypoglycaemia and reduced compliance with therapeutic recommendations to avoid hypoglycaemia seen in IAH patients.
We aim to recruit 15 healthy controls [HC], 15 HA and 30 IAH patients with T1DM. Using specialised magnetic resonance imaging (a technique with no radiation exposure), we will study brain activation patterns during controlled hypoglycaemia (2.6mmol/L).
We will:
A) Define the impact of T1DM on brain responses to acute hypoglycaemia by comparing HC and HA.
B) Confirm the differences in regional brain activation in response to hypoglycaemia between HA and IAH.
C) Determine if characteristic brain responses to hypoglycaemia in IAH are reversible after rigorous hypoglycaemia avoidance.
D) Investigate neuroimaging, psychological and behavioural factors that may predict IAH and the ability to restore awareness.These studies will help us better understand underlying mechanisms of IAH and target interventions more effectively. Longer-term, this may help develop potential psychological and pharmacological interventions for resistant IAH.
REC name
London - Dulwich Research Ethics Committee
REC reference
13/LO/1821
Date of REC Opinion
22 Jan 2014
REC opinion
Further Information Favourable Opinion