Low-Dose Terbutaline Can Prevent Nocturnal Hypoglycemia in Type 1’s

A 2.5-mg dose of terbutaline at bedtime appears to prevent hypoglycemia during the night in patients with aggressively treated type 1 diabetes, without causing hyperglycemia the following morning, results of a pilot study indicate.

Dr. Philip E. Cryer and colleagues at Washington University School of Medicine in St. Louis previously reported that a 5-mg dose of the beta-2-adrenergic agonist prevented nocturnal hypoglycemia, but blood glucose levels were high the next morning.

For their current randomized, double-blind, crossover trial, 15 patients (mean age 29 years; mean HgA1c 7.1%) were given one of two doses of terbutaline (2.5 or 5.0 mg) or placebo on three separate evenings at 10:00 p.m.

Results published in the December issue of Diabetes Care showed that mean nadir nocturnal plasma glucose concentrations were 87, 100, and 122 mg/dL following placebo, 2.5 mg terbutaline, and 5 mg terbutaline treatment, respectively. Corresponding levels at 7:00 the next morning were 113, 127, and 183 mg/dL.

Five patients had nadir levels < 50 mg/dL after taking placebo, and two had levels that low after taking low-dose terbutaline. None of those taking the higher dose had nadir levels < 60 mg/dL.

Even though the trial was too small to show statistically significant differences between placebo and low-dose terbutaline, the authors note, “the key efficacy end points… were intermediate between those taking placebo at bedtime and those taking 5.0 mg terbutaline at bedtime.”

Dr. Cryer’s team concludes that “terbutaline may be shown to be effective and safe in the prevention of nocturnal hypoglycemia in type 1 diabetes in a suitably powered randomized controlled trial.”

Diabetes Care 2008;31:2271-2272.