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Nasal glucagon a desirable needle-free alternative for hypoglycaemia treatment in children

Jairia Dela Cruz
19 Sep 2017

Intranasal delivery of dry powder glucagon in paediatric type 1 diabetes (T1D) patients with moderate to severe hypoglycaemia appears to induce recovery over half an hour, with the rise in blood glucose occurring within 15 minutes, according to a study presented at the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD 2017).

Easy to administer and rated satisfactory or very satisfactory by most caregivers, the 3-mg glucagon powder offers a viable alternative to injectable glucagon for the management of moderate to severe hypoglycaemia in home or school settings, the authors said.

The open-label, single-arm study included 15 hypoglycaemic patients (64 percent male) aged 5 to 17 years with a mean T1D duration of 6.3 years. A single nasal glucagon dose (3 mg) was administered for any naturally occurring moderate or severe hypoglycaemic episode.

Caregivers measured the patients’ blood glucose prior to or immediately after treatment and again at 15, 30 and 45 minutes after dosing. They also reported symptoms and clinical response using questionnaires, as well as subjectively evaluated nasal glucagon ease-of-use.

Results showed that all patients had their hypoglycaemia symptoms resolved, and return to normal status (as assessed by the caregiver) occurred within 30 minutes of nasal glucagon administration. The patients required no additional emergency health services. [EASD 2017, abstract 736]

Blood glucose particularly increased within 15 minutes of treatment and kept on rising through 45 minutes. A total of 33 episodes of moderate hypoglycaemia were reported in 14 patients (mean, 2.4 episodes per patient) post-treatment, and no episode of severe hypoglycaemia occurred.

The most frequently observed adverse events were watery eyes and nasal discomfort, and many of such events were reversed within an hour.

Overall satisfaction with the nasal glucagon was very high among the caregivers. About 87 percent reported that kit instructions were very easy to understand, while 93 percent said the treatment was very easy to administer (done in less than 30 seconds in 61 percent of hypoglycaemia episodes).

“Currently, treatment of severe hypoglycaemia outside of hospital settings is mostly limited to injectable glucagon,” the authors noted.

Injectable glucagon kits contain a vial of powdered glucagon, a syringe prefilled with diluent and instructions for reconstitution/administration of the drug. The multistep reconstitution and injection procedure may pose substantial risk of errors, especially in consideration of some caregivers who have no medical training. [Diabetes Metab Syndr Obes 2011;4:337-346; Diabetes Technol Ther 2016;18:292-297]

On the other hand, nasal glucagon is a single-dose drug combination device that is ready to use and allows simple, one-step and needle-free treatment administration, the authors said.

Furthermore, the device does not require patients to inhale or breathe deeply, they added. Thus, an intranasal mode of glucagon delivery may be desirable.

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