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Terbutaline prevented nocturnal hypoglycemia in patients with type 1 diabetes
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Terbutaline may be a safe and effective treatment option for prevention of nocturnal hypoglycemia in patients with type 1 diabetes.
Researchers of a randomized, controlled trial examined whether terbutaline prevented nocturnal hypoglycemia without causing morning hyperglycemia in 15 patients with type 1 diabetes.
Patients randomly assigned to 2.5 mg terbutaline (Brethine, Novartis) had a mean nadir nocturnal plasma glucose concentration of 100 mg/dL compared with 122 mg/dL with 5 mg terbutaline and 87 mg/dL with placebo (see chart). In the 2.5-mg terbutaline group, seven patients reached nadir nocturnal concentrations <70 mg/dL, six reached concentrations <60 mg/dL and two reached concentrations <50 mg/dL. Further, three patients assigned to 5-mg terbutaline reached nadir levels <70 mg/dL; none of these patients reached any level lower than that.
Morning plasma glucose levels were 127 mg/dL with 2.5 mg terbutaline, 183 mg/dL with 5 mg terbutaline and 113 mg/dL with placebo.
“These data confirm a high frequency of nocturnal hypoglycemia in patients with aggressively treated type 1 diabetes. These data also confirm that bedtime administration of 5 mg terbutaline effectively prevents nocturnal hypoglycemia,” the researchers wrote.
“Documentation of the efficacy and safety of bedtime administration of terbutaline in the prevention of nocturnal hypoglycemia in patients with type 1 diabetes will require a suitably powered randomized, controlled trial of relatively long-term terbutaline administration,” they wrote. – by Katie Kalvaitis
Diabetes Care. 2008;31:2271-2272.
Hypoglycemia is the limiting step to glycemic control in patients with diabetes. It can be serious and is occasionally fatal. The majority of hypoglycemic episodes occur at night. Therefore, efforts to reduce the risk of nocturnal hypoglycemia would be well directed. The group of Cryer et al at Washington University have made a life career of addressing the biology of hypoglycemia. This report is a follow-up of earlier work from the same laboratory showing a beneficial effect of terbutaline (5 mg) in decreasing hypoglycemia overnight, but that dose was associated with undesirable hyperglycemia in the morning. The current study tested a smaller dose (2.5 mg) of terbutaline and seems to have nailed the matter squarely. It seems, therefore, that terbutaline can be added to other existing strategies for reduction of nocturnal hypoglycemia. These other strategies include bedtime caloric supply, recalibration of antidiabetic medications, limitation of alcohol intake, exercise counseling, self-blood glucose monitoring (especially in the ‘wee’ hours), prompt recognition and intervention for hypoglycemia unawareness, among others. The fact that the study included just 15 patients with type 1 diabetes is an obvious limitation. Therefore, a larger study expanded to even patients with type 2 diabetes (many of whom are also at risk for hypoglycemia) would be most welcome.
– Samuel Dagogo-Jack, MD
Endocrine Today Editorial Board member