Intranasal glucagon compared with subcutaneous glucagon

StudyPopulationInterventionOutcomesResultsCommentsDesignEL
Stenninger and Aman, 199349012 children with type 1 diabetes
Aged 7 to 12 years
Sweden
Hypoglycaemia (blood glucose 1.6 ± 0.1 vs. 1.8 ± 0.2 mmol/l) induced by continuous insulin and variable glucose infusions
Children were randomised to 1 of 2 treatments, 1 week later the other treatment was received
  1. intranasal glucagon powder with DDPC, an absorption enhancer (1 mg IN)
  2. subcutaneous glucagon (0.5 mg SC)
  1. Plasma glucose and glucagon levels before glucagon and at 5, 10, 15, 20, 25, 30, 45 and 60 min after treatment was given
  2. Adverse effects: degree of nausea was graded by each child, irritation of nasal mucosa scale 1–10 (1 = no nausea or no nasal irritation to 10 = maximal nausea or irritation)
  1. child was excluded due to severe hypoglycaemia symptoms
    Blood glucose concentration after 15 min of treatment were almost identical during the two treatments (IN 1.5 ± 0.2 mmol/l and SC 1.7 ± 0.2 mmol/l p > 0.05) at 30 min the increase in blood glucose tended to be lower in the I. N. group, but no significant difference was detected until 45 min after the treatments had been given (1.2 ± 0.2 mmol/l, IN vs. 2.2 ± 0.4 mmol/l, SC p<0.05)
    Glucagon concentration after 5 min. of treatment there was no significantly different between the two treatment groups (IN 1.v0.3 ng/ml and SC 1.9 ± 0.3 ng/ml p > 0.05) after 10 min. the glucagon concentrations was significantly lower in the IN treated children (p < 0.05). The peak glucagon concentration 1.6 ± 0.4 ng/ml was observed after 10min. in the IN treated children and after 15 min, 2.6 ± 0.3 ng/ml, in the SC treated children. For the remainder of the study the glucagon concentration was twice as high in the S.C treated children compared with the IN treated children
  2. 10/11 children given SC treatment had severe nausea 90 min after treatment. After IN treatment 1/11 child complained of nausea. Mild nasal irritation was reported by 4 children. Minimal nasal irritation was observed when the nasal mucosa was inspected
No description of how randomisation took place
No details of blinding of the study
Does induced hypoglycaemia act in the same way as accidental hypoglycaemia?
RCT crossoverIb
Slama, 19904916 adult patients with type 1 diabetes
Aged 29.6 ± 7.7 years (mean ± SEM)
France
Adults were randomised to 1 of 2 treatments after induced severe hypoglycaemia (blood glucose < 2.5 mmol/l)
  1. intranasal glucagon powder pellet (1 mg IN)
  2. subcutaneous glucagon (1 mg SC)
Plasma glucose levelsNo statistical difference in the plasma glucose profile between the two treatment groups (graph for initial 30 min shown, no numerical data given)No description of how randomisation took place
No details of blinding of the study
Does induced hypoglycaemia act in the same way as accidental hypoglycaemia?
RCTIb

From: Evidence tables

Cover of Type 1 Diabetes
Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People.
NICE Clinical Guidelines, No. 15.2.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2004 Sep.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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