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Nasal glucagon viable option for type 1 diabetes
SAN DIEGO — Moderate to severe hypoglycemic episodes in adults with type 1 diabetes may effectively be treated with nasal glucagon, and caregivers can safely administer the medication, according to findings presented here.
“Research has already demonstrated that 3 mg of nasal glucagon is safe, effective and easy to use,” Elizabeth R. Seaquist, MD, professor of medicine and director of the division of diabetes, endocrinology and metabolism at the University of Minnesota, said during a presentation here.
Seaquist and colleagues evaluated 3-mg nasal glucagon for efficacy and ease of use in moderate or severe hypoglycemic episodes in adults with type 1 diabetes. Caregivers of participants were instructed how to administer nasal glucagon for symptomatic hypoglycemic episodes and to assess for normal blood glucose status over time. The study’s primary endpoint was return to normal glucose status within 30 minutes. Patients and caregivers completed questionnaires to report on hypoglycemic symptoms, blood glucose, adverse events and ease of use.
The efficacy population included 157 hypoglycemic episodes among 69 participants. Researchers found that 96.2% of the episodes were reversed, and patients returned to normal glucose status within 30 minutes. Six episodes did not return to normal glucose status within 30 minutes: In five events, participants recovered within 30 to 45 minutes; blood glucose was at least 70 mg/dL at 30 minutes in four episodes. At hypoglycemic episode onset, mean blood glucose was 47.9 mg/dL and rose to 112.8 mg/dL by 30 minutes and then progressively over time. Seven participants experienced 12 severe hypoglycemic episodes, and all were resolved within 15 minutes. Administration time for nasal glucagon was less than 30 seconds in 70.4% of episodes and less than 2 minutes in 97.7%.
“The study demonstrated that nasal glucagon is effective in treating moderate and severe hypoglycemia in adults with type 1 diabetes in the real-world setting,” Seaquist said. “This study demonstrated that administration of nasal glucagon restored most study participants to awakening or to return to normal state within 30 minutes. Additionally, emergency services were not needed for any participants in the study.”
The safety population included 179 hypoglycemic episodes among 74 participants, and at least one adverse event was experienced by 87.8% of participants — the most common was nasal irritation (82.4%), followed by headache (54.1%). Hypoglycemic episodes lasted for 1 hour or less in 59.5% and were of mild or moderate severity. Caregivers said they were satisfied or very satisfied with nasal glucagon after 82.7% of hypoglycemic episodes. There were no serious drug-related adverse events.
“The study shows that 3 mg of glucagon administered as a dry powder into the nose using the device examined in the study is an effective and well-accepted treatment for moderate and severe hypoglycemia in a real-world setting,” Seaquist said. “This will offer patients and their families an alternative to injectable glucagon, which should help more families help a loved one more effectively and quickly than the currently available treatments.” – by Amber Cox
Reference:
Seaquist ER, et al. 357-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosure: Seaquist reports consulting for Eli Lilly and Novo Nordisk.