Medical Therapy in Patients with Endogenous Hypoglycaemia: is Euglycaemia Achievable?

Abstract

Context

While the only curative treatment for patients with endogenous hypoglycaemia related to inappropriate insulin or to insulin growth factor 2 (IGF2) secretion is surgery, medical treatment to normalise plasma glucose levels can be useful.

Objective

The aim of this prospective single centre study was to assess whether patients with endogenous hypoglycaemia, considered euglycaemic with medical treatments, experienced asymptomatic hypo‐ or hyperglycaemic excursions.

Patients and Methods

All patients with endogenous hypoglycaemia related to inappropriate insulin or to IGF2 secretion between 2012 and 2016 and considered normoglycaemic with medical treatment (absence of clinical hypoglycaemia and self‐monitoring blood glucose in the normal range) were enrolled and underwent a six‐day continuous glucose monitoring (CGM) recording.

Results

Twenty‐seven patients (inappropriate insulin secretion n=25 and IGF2 secretion n=2), treated with diazoxide (n=16), somatostatin analogues (n=7), glucocorticoids (n=3) or a combination of these treatments (n=1) were enrolled. Twenty‐five CGMs were analysed. CGM confirmed normoglycaemia in 11/25 patients (44%). Hypoglycaemias below 0.60 g/L were present in 7 patients (28%) and were associated with hyperglycaemic excursions above 1.40 g/L in 5 patients. Seven patients (28%) had only hyperglycaemic excursions. Based on these results, treatment was modified in 14 patients (56%).

Conclusion

Despite the disappearance of hypoglycaemia‐related clinical symptoms and normalisation of blood glucose self‐monitoring data, 56% of the patients with endogenous hypoglycaemia treated with medical therapy experienced asymptomatic hypo‐ and/or hyperglycaemia. Continuous glucose monitoring could be a useful approach to reveal and prevent hypo‐ or hyperglycaemic excursions.

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