Dead-in-bed syndrome
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Robert G. Badgett, M.D.[2]
Dead-in-bed syndrome unexpected death in young type 1 diabetic patients "with no history of diabetic complications, and in particular no autonomic dysfunction. They are found in an undisturbed bed, which seems to exclude death during a convulsive attack"[1].
This was first described in a series of 20 patients in 1991[2].
Etiology
Proposed causes include:
- Hypoglycemic unawareness[3][4] or the 'hypoglycemia-unawareness syndrome'[5]
- Hypoglycemia-induced ventricular dysrhythmia due to QT prolongation during hypoglycemia[6][7]
- Hypoglycemia-induced autonomic dysfunction which may lead to ventricular dysrhythmia due to QT prolongation[8]
Diagnosis
Diabetic ketoacidosis may be sought during autopsy by vitreous fluid biochemical analyses [9].
Prevention
Nocturnal hypoglycemia may be prevented by glucose sensors
Clinical practice guidelines by the American Diabetic Association recommend[10]:
- "For patients with frequent nocturnal hypoglycemia, recurrent severe hypoglycemia, and/or hypoglycemia unawareness, a sensor-augmented low glucose threshold suspend pump may be considered."
Randomized controlled trials support this recommendation[11][12].
The MiniMed(®) Paradigm™ Veo system (Medtronic Inc., Northridge, CA, USA) may be the most effective system[13].
Sensors may not completely prevent dead in bed syndrome[14]
References
- ↑ Sovik O, Thordarson H (1999). "Dead-in-bed syndrome in young diabetic patients". Diabetes Care. 22 Suppl 2: B40–2. PMID 10097898.
- ↑ Tattersall RB, Gill GV (1991). "Unexplained deaths of type 1 diabetic patients". Diabet Med. 8 (1): 49–58. PMID 1826245.
- ↑ Hanas R (1997). "Dead-in-bed syndrome in diabetes mellitus and hypoglycaemic unawareness". Lancet. 350 (9076): 492–3. doi:10.1016/S0140-6736(05)63081-4. PMID 9274591.
- ↑ Gerich JE, Mokan M, Veneman T, Korytkowski M, Mitrakou A (1991). "Hypoglycemia unawareness". Endocr Rev. 12 (4): 356–71. doi:10.1210/edrv-12-4-356. PMID 1760993.
- ↑ Schultes B, Jauch-Chara K, Gais S, Hallschmid M, Reiprich E, Kern W; et al. (2007). "Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus". PLoS Med. 4 (2): e69. doi:10.1371/journal.pmed.0040069. PMC 1808097. PMID 17326710.
- ↑ Gill GV, Woodward A, Casson IF, Weston PJ (2009). "Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes--the 'dead in bed' syndrome revisited". Diabetologia. 52 (1): 42–5. doi:10.1007/s00125-008-1177-7. PMID 18972096.
- ↑ Marques JL, George E, Peacey SR, Harris ND, Macdonald IA, Cochrane T; et al. (1997). "Altered ventricular repolarization during hypoglycaemia in patients with diabetes". Diabet Med. 14 (8): 648–54. doi:10.1002/(SICI)1096-9136(199708)14:8<648::AID-DIA418>3.0.CO;2-1. PMID 9272590.
- ↑ Weston PJ, Gill GV (1999). "Is undetected autonomic dysfunction responsible for sudden death in Type 1 diabetes mellitus? The 'dead in bed' syndrome revisited". Diabet Med. 16 (8): 626–31. PMID 10477206.
- ↑ Luna J, Gilliland MG, Hewan-Lowe KO, Tanenberg RJ (2014). "Postmortem Diagnosis of Diabetic Ketoacidosis Presenting as the "Dead-in-Bed Syndrome"". Endocr Pract. 20 (7): e123–5. doi:10.4158/EP13473.CR. PMID 24641923.
- ↑ American Diabetes Association (2016). "7. Approaches to Glycemic Treatment". Diabetes Care. 39 Suppl 1: S52–9. doi:10.2337/dc16-S010. PMID 26696682.
- ↑ Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW (2013). "Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial". JAMA. 310 (12): 1240–7. doi:10.1001/jama.2013.277818. PMID 24065010.
- ↑ Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH; et al. (2013). "Threshold-based insulin-pump interruption for reduction of hypoglycemia". N Engl J Med. 369 (3): 224–32. doi:10.1056/NEJMoa1303576. PMID 23789889. Review in: Ann Intern Med. 2013 Sep 17;159(6):JC7
- ↑ Riemsma R, Corro Ramos I, Birnie R, Büyükkaramikli N, Armstrong N, Ryder S; et al. (2016). "Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation". Health Technol Assess. 20 (17): v–xxxi, 1–251. doi:10.3310/hta20170. PMC 4809467. PMID 26933827.
- ↑ Waheed N, Butt M, Dayan C. Hypoglycaemia documented with real-time continuous glucose sensing in a case of ‘dead in bed’ syndrome. Practical Diabetes. 30(1):33–5. doi:10.1002/pdi.1737