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. 2025 Jun 4.
doi: 10.1007/s42000-025-00680-0. Online ahead of print.

Post-hypoglycemic nocturnal hyperglycemia in type 1 diabetes: the Somogyi hypothesis revisited

Tomás González-Vidal  1   2   3 , Diego Rivas-Otero  4   5   6 , Pablo Agüeria-Cabal  4 , Guillermo Ramos-Ruiz  4 , Carmen Lambert  5 , Jessica Ares-Blanco  4   5   6 , Edelmiro Menéndez-Torre  4   5   6   7 , Elías Delgado  4   5   6   7
Affiliations

Post-hypoglycemic nocturnal hyperglycemia in type 1 diabetes: the Somogyi hypothesis revisited

Tomás González-Vidal et al. Hormones (Athens). .

Abstract

Purpose: The plausibility of the Somogyi phenomenon (dawn hyperglycemia after nocturnal hypoglycemia) has been questioned. The present study used continuous glucose monitoring in patients with type 1 diabetes (T1DM) to investigate the frequency and the associated factors for post-hypoglycemic nocturnal hyperglycemia (PHNH), as well as the overall glycemic control in patients who develop PHNH.

Methods: This study analyzed the nighttime (0:00 am to 6:00 am) glycemic profile of 755 FreeStyle Libre 2 users with T1DM (429 men; median age 49 years, range 18-90 years) during a 14-day period. Patients were divided into three categories, as follows: no nocturnal hypoglycemia (< 70 mg/dL), only nocturnal hypoglycemia that was not followed by hyperglycemia (> 180 mg/dL) before 6:00 am, and ≥ 1 episode of nocturnal hypoglycemia that was followed by hyperglycemia before 6:00 am (PHNH). The patients' characteristics and the overall glycemic control in the 14-day period were also registered.

Results: A total of 248 patients (32.8%) developed PHNH during the 14-day period. Compared with patients who only had nocturnal hypoglycemia that was not followed by hyperglycemia (n = 332), patients with PHNH were younger, were less frequently diagnosed as latent autoimmune diabetes in adults (LADA), and used higher total daily doses of insulin. Patients with PHNH had longer time above range, shorter time in range, higher glucose variability, and more diurnal hypoglycemia than those who only had nocturnal hypoglycemia that was not followed by hyperglycemia before 6:00 am.

Conclusions: PHNH is frequent in T1DM, especially in young individuals. Compared to patients with other forms of nocturnal hypoglycemia, patients with PHNH have poorer glycemic control.

Keywords: Continuous glucose monitoring; Nocturnal hypoglycemia; Somogyi; Type 1 diabetes.

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Conflict of interest statement

Declarations. Ethical approval: The study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments. The study was evaluated and authorized by the Research Ethics Committee of the Principality of Asturias (code 2023.376). Informed consent: The Research Ethics Committee of the Principality of Asturias waived the requirement for informed consent from the study participants, in accordance with Spanish regulations for retrospective studies of medical records. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose.

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References

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