Hypoglycaemia induces a sustained pro‐inflammatory response in people with type 1 diabetes and healthy controls.

Verhulst, Clementine E. M.; van Heck, Julia I. P.; Fabricius, Therese W.; Stienstra, Rinke; Teerenstra, Steven; McCrimmon, Rory J.; Tack, Cees J.; Pedersen‐Bjergaard, Ulrik; de Galan, Bastiaan E.

Aim: To determine the duration and the extension of the pro‐inflammatory response to hypoglycaemia both in people with type 1 diabetes and healthy controls. Materials and Methods: Adults with type 1 diabetes (n = 47) and matched controls (n = 16) underwent a hyperinsulinaemic‐euglycaemic hypoglycaemic (2.8 ± 0.1 mmoL/L [49.9 ± 2.3 mg/dL]) glucose clamp. During euglycaemia, hypoglycaemia, and 1, 3 and 7 days later, blood was drawn to determine immune cell phenotype, monocyte function and circulating inflammatory markers. Results: Hypoglycaemia increased lymphocyte and monocyte counts, which remained elevated for 1 week. The proportion of CD16 monocytes increased and the proportion of CD14 monocytes decreased. During hypoglycaemia, monocytes released more tumour necrosis factor‐α and interleukin‐1β, and less interleukin‐10, after ex vivo stimulation. Hypoglycaemia increased the levels of 19 circulating inflammatory proteins, including high sensitive C‐reactive protein, most of which remained elevated for 1 week. The epinephrine peak in response to hypoglycaemia was positively correlated with immune cell number and phenotype, but not with the proteomic response. Conclusions: Overall, despite differences in prior exposure to hypoglycaemia, the pattern of the inflammatory responses to hypoglycaemia did not differ between people with type 1 diabetes and healthy controls. In conclusion, hypoglycaemia induces a range of pro‐inflammatory responses that are sustained for at least 1 week in people with type 1 diabetes and healthy controls.

TYPE 1 diabetes; HYPOGLYCEMIA; INSULIN aspart; GLUCOSE clamp technique; LYMPHOCYTE count; C-reactive protein

Diabetes, Obesity & Metabolism, 2023, Vol 25, Issue 11, p3114

1462-8902

Academic Journal

10.1111/dom.15205