A new study published in Diabetes Care found that currently approved medicine for asthma, the beta-2 adrenergic receptor (AR) agonist formoterol prevent insulin-induced hypoglycaemia in type 1 diabetes. Dr Renata Belfort-DeAnguiar and her colleagues at Yale University investigated the effectiveness of beta -2 AR in preventing hypoglycaemia in people with type 1 diabetes.

“These findings suggest that inhaled formoterol may have potential value as a preventive therapy for iatrogenic hypoglycemia, particularly in patients with type 1 diabetes with hypoglycemia-associated autonomic failure and frequent episodes of nocturnal hypoglycemia,” the researchers wrote. After a 10-hour overnight fast, participants attended two separate morning visits to receive 48 µg of inhaled formoterol or an inhaled placebo, followed by a hyperinsulinemic euglycemic-hypoglycemic clamp. Researchers initiated an IV infusion of insulin; a 20% dextrose infusion was also initiated and adjusted based on plasma glucose levels to maintain in the euglycemic range for 30 minutes. After 30 minutes, researchers allowed plasma glucose levels to drop freely for 60 minutes, with vital signs measured every 30 minutes and researchers recording symptoms self-reported by participants.

In the second protocol, the five type 1 patients were given 48 mg of inhaled formoterol or placebo, and then their basal insulin infusion was doubled for an hour. Glucose levels dropped to 58 mg/dL at 1 hour in the placebo group, whereas they remained stable in the formoterol group and were twice as high as the levels in the placebo group at the end of the study (P < .05). None of the formoterol patients required a rescue of 20% dextrose infusion, whereas three control subjects required dextrose following placebo to avoid dropping glucose below 55 mg/dL.

At the end of the study, epinephrine levels were significantly lower with formoterol vs placebo (P = .05), but no significant differences were seen in norepinephrine or glucagon levels.

Read More